Provider Demographics
NPI:1972128312
Name:VILLA RUIZ, JOSUE ALEJANDRO (SA-C)
Entity type:Individual
Prefix:
First Name:JOSUE
Middle Name:ALEJANDRO
Last Name:VILLA RUIZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-3823
Mailing Address - Country:US
Mailing Address - Phone:562-650-9601
Mailing Address - Fax:
Practice Address - Street 1:2600 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-3823
Practice Address - Country:US
Practice Address - Phone:562-650-9601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20-183246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant