MEDICARE: DR. SIMON TOBIAS VILLA M.D.

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	2084P0804X	Child & Adolescent Psychiatry Physician	A500910	CA

General Provider Information

NPI Number	:	1659370690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIMON TOBIAS VILLA M.D.

Provider Business Mailing Address
First Line	:	1331 CANYONCREEK ST
Second Line	:
City	:	HANFORD
State	:	CA
Zip	:	93230-6944
Country	:	US
Telephone Number	:	559-582-3949
Fax Number	:

Provider Business Practice Location Address
First Line	:	3133 N MILLBROOK AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93703-1425
Country	:	US
Telephone Number	:	559-453-8918
Fax Number	:

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/08/2007

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