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General NPI Number Information
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NPI Number | 1992513113
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Entity Type | Organization
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Legal Business Name | MARIA THERESA O VILLA, PC
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 655 SATURN BLVD STE J
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City | SAN DIEGO
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State | CA
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Zip | 92154-4734
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Country | US
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Telephone | 619-646-7975
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Fax |
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Provider Business Mailing Address
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Address Line | 655 SATURN BLVD STE J
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City | SAN DIEGO
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State | CA
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Zip | 92154-4734
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Country | US
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Telephone | 619-646-7975
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GEORGE PONCE
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Credential | MD
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Telephone | 951-347-4823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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