Healthcare Provider Details

I. General information

NPI: 1932695962
Provider Name (Legal Business Name): CARMEN DIANA VILLA MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71780 SAN JACINTO DR BLDG I
RANCHO MIRAGE CA
92270-5516
US

IV. Provider business mailing address

71780 SAN JACINTO DR BLDG I
RANCHO MIRAGE CA
92270-5516
US

V. Phone/Fax

Practice location:
  • Phone: 760-568-3461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95009604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: