Provider Demographics
NPI:1861541385
Name:VILLA, MARIA THERESA ORENSE (MD)
Entity type:Individual
Prefix:
First Name:MARIA THERESA
Middle Name:ORENSE
Last Name:VILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:655 SATURN BLVD
Mailing Address - Street 2:SUITE #J
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-4734
Mailing Address - Country:US
Mailing Address - Phone:619-575-4442
Mailing Address - Fax:619-575-1297
Practice Address - Street 1:655 SATURN BLVD
Practice Address - Street 2:SUITE #J
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-4734
Practice Address - Country:US
Practice Address - Phone:619-575-4442
Practice Address - Fax:619-575-1297
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA86224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine