MEDICARE: VILA FACIAL PLASTIC SURGERY

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1720695729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILA FACIAL PLASTIC SURGERY

Provider Business Mailing Address
First Line	:	899 NORTHGATE DR STE 110
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-3664
Country	:	US
Telephone Number	:	415-684-8452
Fax Number	:

Provider Business Practice Location Address
First Line	:	899 NORTHGATE DR STE 110
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-3664
Country	:	US
Telephone Number	:	415-684-8452
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER AND SURGEON
Name	:	DR. PETER MICHAEL VILA
Credential	:	MD, MSPH
Telephone Number	:	415-684-8452

Provider Enumeration Date	:	09/24/2020
Last Update Date	:	03/02/2021

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