Healthcare Provider Details

I. General information

NPI: 1598008435
Provider Name (Legal Business Name): LYDIA NICHOLE VILLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 S MAIN ST
SANTA ANA CA
92701-5712
US

IV. Provider business mailing address

406 S MAIN ST
SANTA ANA CA
92701-5712
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-4815
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA152849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: