Provider Demographics
NPI:1922291228
Name:PAULINO A VILLATORO, MD PC
Entity Type:Organization
Organization Name:PAULINO A VILLATORO, MD PC
Other - Org Name:VILLATORO MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULINO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:VILLATORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-624-0392
Mailing Address - Street 1:1532 E SAN BERNARDINO AVE
Mailing Address - Street 2:SUITE A2
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3559
Mailing Address - Country:US
Mailing Address - Phone:909-624-0392
Mailing Address - Fax:909-624-0984
Practice Address - Street 1:1532 SAN BERNARDINO AVE
Practice Address - Street 2:SUITE A2
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3559
Practice Address - Country:US
Practice Address - Phone:909-624-0392
Practice Address - Fax:909-624-0984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52491208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A524911Medicaid
CAW22079Medicare PIN