Provider Demographics
NPI:1154518207
Name:RH VILLAROSA, M.D., INC.
Entity type:Organization
Organization Name:RH VILLAROSA, M.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAROSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-793-2226
Mailing Address - Street 1:255 TERRACINA BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4870
Mailing Address - Country:US
Mailing Address - Phone:909-793-2226
Mailing Address - Fax:909-793-3336
Practice Address - Street 1:255 TERRACINA BLVD STE 207
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4870
Practice Address - Country:US
Practice Address - Phone:909-793-2226
Practice Address - Fax:909-793-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C504630Medicaid
CAC50453OtherLICENSE
CAF95727Medicare UPIN
CA00C504630Medicaid