Healthcare Provider Details

I. General information

NPI: 1679935811
Provider Name (Legal Business Name): PATRICIA F. VILLEGAS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2016
Last Update Date: 04/30/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 ZONAL AVE FL OPD5
LOS ANGELES CA
90033
US

IV. Provider business mailing address

2020 ZONAL AVE IRD 112
LOS ANGELES CA
90033
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-3680
  • Fax:
Mailing address:
  • Phone: 323-409-5707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A15919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: