Healthcare Provider Details

I. General information

NPI: 1144368945
Provider Name (Legal Business Name): ALEXANDER VILLICANA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 W. DUARTE ROAD SUITE 201
ARCADIA CA
91007-9261
US

IV. Provider business mailing address

624 W. DUARTE ROAD SUITE 201
ARCADIA CA
91007-9261
US

V. Phone/Fax

Practice location:
  • Phone: 626-792-6127
  • Fax: 626-796-6936
Mailing address:
  • Phone: 626-792-6127
  • Fax: 626-796-6936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA21627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: