Provider Demographics
NPI:1104658533
Name:VILLA, ALEXANDRA (DC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:VILLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E JEANETTE LN UNIT G106
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-6023
Mailing Address - Country:US
Mailing Address - Phone:707-331-0458
Mailing Address - Fax:
Practice Address - Street 1:301 E JEANETTE LN UNIT G106
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6023
Practice Address - Country:US
Practice Address - Phone:707-331-0458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37022111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor