Provider Demographics
NPI:1740840198
Name:VILLAR, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:VILLAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S GRAND AVE STE 213
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4434
Mailing Address - Country:US
Mailing Address - Phone:714-796-8381
Mailing Address - Fax:714-567-7633
Practice Address - Street 1:1300 S GRAND AVE STE 213
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4434
Practice Address - Country:US
Practice Address - Phone:714-796-8381
Practice Address - Fax:714-567-7633
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker