Provider Demographics
NPI:1922198399
Name:VILLA, BEATRIZ (PA)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:VILLA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BEATRIZ
Other - Middle Name:
Other - Last Name:HAMMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3975 JACKSON ST STE 207
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3948
Mailing Address - Country:US
Mailing Address - Phone:951-352-2092
Mailing Address - Fax:
Practice Address - Street 1:3975 JACKSON ST STE 207
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3948
Practice Address - Country:US
Practice Address - Phone:951-352-2092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15430363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant