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NPI Code Detail

MEDICARE: THE VILLA MEDICAL GROUP PLLC

MEDICARE: THE VILLA MEDICAL GROUP PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM2500XMedical Specialty Clinic/Center

General Provider Information

NPI Number : 1306771373
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE VILLA MEDICAL GROUP PLLC
Provider Business Mailing Address
First Line : 15203 NE 72ND AVE
Second Line :
City : VANCOUVER
State : WA
Zip : 98686-1929
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 15203 NE 72ND AVE
Second Line :
City : VANCOUVER
State : WA
Zip : 98686-1929
Country : US
Telephone Number : 360-209-4449
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DANIEL ROA-TREBOL
Credential :
Telephone Number : 541-720-8789
Provider Enumeration Date : 06/12/2026
Last Update Date : 06/12/2026

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Directions to “THE VILLA MEDICAL GROUP PLLC ” Practice Location

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