Healthcare Provider Details

I. General information

NPI: 1497583603
Provider Name (Legal Business Name): IGNACIO VILLA AGUILAR JR. RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

4245 WILLIAMS AVE
LA VERNE CA
91750-3105
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-5000
  • Fax:
Mailing address:
  • Phone: 323-333-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number699607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: