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NPI Code Detail

MEDICARE: MR. CARLOS ISAAC VILLARREAL PA

MEDICARE:  MR. CARLOS ISAAC VILLARREAL  PA
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
1363A00000XPhysician Assistant20538CA

General Provider Information

NPI Number : 1629301601
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CARLOS ISAAC VILLARREAL PA
Provider Business Mailing Address
First Line : 3612 1/2 E 1ST ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90063-2326
Country : US
Telephone Number : 626-824-8461
Fax Number :
Provider Business Practice Location Address
First Line : 3612 1/2 E 1ST ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90063-2326
Country : US
Telephone Number : 323-264-7796
Fax Number : 323-264-7778
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2009
Last Update Date : 12/15/2021

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Directions to “ MR. CARLOS ISAAC VILLARREAL PA” Practice Location

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