Provider Demographics
NPI:1992871941
Name:VILLAPUDUA, DINA L (PA)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:L
Last Name:VILLAPUDUA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9502 MONTERRA WAY
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4260
Mailing Address - Country:US
Mailing Address - Phone:714-469-8868
Mailing Address - Fax:
Practice Address - Street 1:9502 MONTERRA WAY
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4260
Practice Address - Country:US
Practice Address - Phone:714-469-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18416363A00000X
CAPA 18416207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0097000OtherPROVIDER NUMBER
CAGR0097001OtherPROVIDER NUMBER