MEDICARE: JESSEL REMOROZA VILLEGAS PHARMD, BCCCP

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
1	1835C0205X	Critical Care Pharmacist	77166	CA
2	183500000X	Pharmacist	77166	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	77166	OTHER	CA	CALIFORNIA BOARD OF PHARMACY

General Provider Information

NPI Number	:	1376190116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSEL REMOROZA VILLEGAS PHARMD, BCCCP

Provider Business Mailing Address
First Line	:	PO BOX 7667
Second Line	:
City	:	ALHAMBRA
State	:	CA
Zip	:	91802-7667
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	757 WESTWOOD PLZ
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-5504
Country	:	US
Telephone Number	:	310-825-9111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2019
Last Update Date	:	06/12/2021

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