Provider Demographics
NPI:1992513113
Name:MARIA THERESA O VILLA, PC
Entity type:Organization
Organization Name:MARIA THERESA O VILLA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PONCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-347-4823
Mailing Address - Street 1:655 SATURN BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-4734
Mailing Address - Country:US
Mailing Address - Phone:619-646-7975
Mailing Address - Fax:
Practice Address - Street 1:655 SATURN BLVD STE J
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-4734
Practice Address - Country:US
Practice Address - Phone:619-646-7975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty