Healthcare Provider Details

I. General information

NPI: 1790743359
Provider Name (Legal Business Name): SILVIA M VILLAGOMEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FRANK H OGAWA PLZ STE 355
OAKLAND CA
94612-2088
US

IV. Provider business mailing address

300 FRANK H OGAWA PLZ STE 355
OAKLAND CA
94612-2088
US

V. Phone/Fax

Practice location:
  • Phone: 510-444-3297
  • Fax: 510-444-6421
Mailing address:
  • Phone: 510-444-3297
  • Fax: 510-444-6421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG71593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: