MEDICARE: MRS. IRIS M VILLANUEVA DMSC, PA-C

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	363A00000X	Physician Assistant	51614	CA

General Provider Information

NPI Number	:	1750792149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IRIS M VILLANUEVA DMSC, PA-C

Provider Business Mailing Address
First Line	:	PO BOX 255228
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95865-5228
Country	:	US
Telephone Number	:	866-978-8837
Fax Number	:

Provider Business Practice Location Address
First Line	:	5406 SUNRISE BLVD STE 3
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-7854
Country	:	US
Telephone Number	:	800-972-5554
Fax Number	:

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

Provider Enumeration Date	:	05/19/2014
Last Update Date	:	04/14/2026

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