Provider Demographics
NPI:1811418577
Name:CAUSIN, JOSE ROMELITO VILLACARLOS (AGNP-C)
Entity Type:Individual
Prefix:
First Name:JOSE ROMELITO
Middle Name:VILLACARLOS
Last Name:CAUSIN
Suffix:
Gender:M
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 ST PAUL AVE APT 457B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-6021
Mailing Address - Country:US
Mailing Address - Phone:202-746-8210
Mailing Address - Fax:
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-1160
Practice Address - Fax:310-423-4646
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005768363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty