Healthcare Provider Details

I. General information

NPI: 1407099203
Provider Name (Legal Business Name): JOSE D VILLARICA, M.D, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PLAZA DR
ROSEVILLE CA
95661-3037
US

IV. Provider business mailing address

8227 OAK KNOLL DR
GRANITE BAY CA
95746-9373
US

V. Phone/Fax

Practice location:
  • Phone: 916-208-8114
  • Fax:
Mailing address:
  • Phone: 916-208-8114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE D VILLARICA
Title or Position: DIRECTOR
Credential: MD
Phone: 916-208-8114