Provider Demographics
NPI:1942971726
Name:VILLA, ANGEL GABRIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:GABRIEL
Last Name:VILLA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13813 W KEIM DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-5343
Mailing Address - Country:US
Mailing Address - Phone:602-478-4399
Mailing Address - Fax:
Practice Address - Street 1:13813 W KEIM DR
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-5343
Practice Address - Country:US
Practice Address - Phone:602-478-4399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1186141363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant