Healthcare Provider Details

I. General information

NPI: 1902976988
Provider Name (Legal Business Name): MERCEDES PERALTA VILLANO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26900 NEWPORT RD STE 110
MENIFEE CA
92584-9224
US

IV. Provider business mailing address

128 OAKTREE DR
PERRIS CA
92571-2771
US

V. Phone/Fax

Practice location:
  • Phone: 951-672-8060
  • Fax: 951-672-7490
Mailing address:
  • Phone: 951-657-2286
  • Fax: 951-672-7490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA26494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: