Healthcare Provider Details

I. General information

NPI: 1740840198
Provider Name (Legal Business Name): MARIA VILLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S GRAND AVE STE 213
SANTA ANA CA
92705-4434
US

IV. Provider business mailing address

1300 S GRAND AVE STE 213
SANTA ANA CA
92705-4434
US

V. Phone/Fax

Practice location:
  • Phone: 714-796-8381
  • Fax: 714-567-7633
Mailing address:
  • Phone: 714-796-8381
  • Fax: 714-567-7633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: