Provider Demographics
NPI:1083435663
Name:VILLA, ADOLF ALISTAIR DAWIS
Entity type:Individual
Prefix:
First Name:ADOLF ALISTAIR
Middle Name:DAWIS
Last Name:VILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2738 GRIFFITH AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-5603
Mailing Address - Country:US
Mailing Address - Phone:216-762-7300
Mailing Address - Fax:
Practice Address - Street 1:2738 GRIFFITH AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-5603
Practice Address - Country:US
Practice Address - Phone:216-762-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA571599163WC1500X
CACPT-02040628246RP1900X
CA95395120163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy