Healthcare Provider Details

I. General information

NPI: 1487562674
Provider Name (Legal Business Name): VILLA MEDICAL GROUP, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 E VILLA ST
PASADENA CA
91107-2452
US

IV. Provider business mailing address

2155 E VILLA ST
PASADENA CA
91107-2452
US

V. Phone/Fax

Practice location:
  • Phone: 626-797-7470
  • Fax: 626-797-1758
Mailing address:
  • Phone: 626-797-7470
  • Fax: 626-797-1758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. WARREN LEE
Title or Position: OWNER
Credential: MD MHS
Phone: 626-797-7470