Healthcare Provider Details

I. General information

NPI: 1750792149
Provider Name (Legal Business Name): IRIS M VILLANUEVA DMSC, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRIS M LEHMAN MMS, PA-C

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5406 SUNRISE BLVD STE 3
CITRUS HEIGHTS CA
95610-7854
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 800-972-5554
  • Fax:
Mailing address:
  • Phone: 866-978-8837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number51614
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: