Healthcare Provider Details

I. General information

NPI: 1992746275
Provider Name (Legal Business Name): REX B VILLEGAS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 E COLORADO BLVD STE 150
PASADENA CA
91107-3747
US

IV. Provider business mailing address

14726 RAMONA AVE STE 203408
CHINO CA
91710-5730
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-4168
  • Fax:
Mailing address:
  • Phone: 626-305-9100
  • Fax: 626-305-0152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT12668T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: