Provider Demographics
NPI:1285756809
Name:VILLAROMAN, EMIL GUANSING JR
Entity type:Individual
Prefix:DR
First Name:EMIL
Middle Name:GUANSING
Last Name:VILLAROMAN
Suffix:JR
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 1:3254 N TRACY BLVD
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-1747
Mailing Address - Country:US
Mailing Address - Phone:209-832-8883
Mailing Address - Fax:209-832-8929
Practice Address - Street 1:3254 N TRACY BLVD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-1747
Practice Address - Country:US
Practice Address - Phone:209-832-8883
Practice Address - Fax:209-832-8929
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 441201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice