Healthcare Provider Details

I. General information

NPI: 1518919604
Provider Name (Legal Business Name): ALEXANDER A VILLARASA, MD INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N INDIAN CANYON DR SUITE W400
PALM SPRINGS CA
92262-4800
US

IV. Provider business mailing address

1180 N INDIAN CANYON DR SUITE W400
PALM SPRINGS CA
92262-4800
US

V. Phone/Fax

Practice location:
  • Phone: 760-416-5010
  • Fax: 760-416-5001
Mailing address:
  • Phone: 760-416-5010
  • Fax: 760-416-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA34432
License Number StateCA

VIII. Authorized Official

Name: DR. ALEXANDER ALCANTRA VILLARASA
Title or Position: CEO
Credential: M.D.
Phone: 760-416-5010