Provider Demographics
NPI:1952310641
Name:VILLA, MONICA MARIE (PA)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:MARIE
Last Name:VILLA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 30TH ST
Mailing Address - Street 2:#508
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3310
Mailing Address - Country:US
Mailing Address - Phone:925-274-4950
Mailing Address - Fax:925-274-4975
Practice Address - Street 1:411 30TH ST
Practice Address - Street 2:#508
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3310
Practice Address - Country:US
Practice Address - Phone:925-274-4950
Practice Address - Fax:925-274-4975
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18349363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q70983Medicare UPIN
Q70983Medicare UPIN