MEDICARE: AMAIRANI VILLASENOR PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA58828	CA

General Provider Information

NPI Number	:	1609470947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMAIRANI VILLASENOR PA-C

Provider Business Mailing Address
First Line	:	5877 GRAND AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-1327
Country	:	US
Telephone Number	:	951-290-1253
Fax Number	:

Provider Business Practice Location Address
First Line	:	29829 SANTA MARGARITA PKWY STE 500
Second Line	:
City	:	RANCHO SANTA MARGARITA
State	:	CA
Zip	:	92688-3623
Country	:	US
Telephone Number	:	949-858-3376
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2020
Last Update Date	:	05/28/2024

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