Healthcare Provider Details

I. General information

NPI: 1093543811
Provider Name (Legal Business Name): HERNAN VILLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 SUNRISE VISTA DR STE 2100
CITRUS HEIGHTS CA
95610-7068
US

IV. Provider business mailing address

6060 SUNRISE VISTA DR STE 2100
CITRUS HEIGHTS CA
95610-7068
US

V. Phone/Fax

Practice location:
  • Phone: 916-967-6253
  • Fax:
Mailing address:
  • Phone: 916-967-6253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: