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General NPI Number Information
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NPI Number | 1972918969
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Entity Type | Individual
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Provider Name | ALFRED DAVID VILLASENOR M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2014
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Last Update Date | 02/17/2017
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Provider Practice Location Address
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Address Line | 100 INDEPENDENCE CIR
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City | CHICO
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State | CA
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Zip | 95973-0258
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Country | US
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Telephone | 310-714-6990
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Fax |
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Provider Business Mailing Address
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Address Line | 100 INDEPENDENCE CIR
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City | CHICO
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State | CA
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Zip | 95973-0258
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Country | US
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Telephone | 310-714-6990
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A141670
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License Number State | CA
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