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General NPI Number Information
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NPI Number | 1053152462
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Entity Type | Organization
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Legal Business Name | LEONEL VILLA
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | AV REVOLUVION Y CALLE 17
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City | SAN LUIS RIO COLORADO
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State | SONORA
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Zip | 83448
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Country | MX
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Telephone | 619-209-8924
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Fax | 916-625-1368
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Provider Business Mailing Address
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Address Line | 2013 DAIRY MART RD UNIT 3
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City | SAN YSIDRO
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State | CA
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Zip | 92173-1848
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Country | US
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Telephone | 619-209-8924
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Fax | 916-625-1368
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Authorized Official
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Title or Position | CLAIMS DENTAL DEPARMENT
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Name | HECTOR MORALES
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Credential |
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Telephone | 619-209-8924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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