Provider Demographics
NPI:1992891998
Name:PETER J VILLALPANDO
Entity type:Organization
Organization Name:PETER J VILLALPANDO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:VILLALPANDO
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:925-952-9500
Mailing Address - Street 1:2570 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:SUITE A105
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1637
Mailing Address - Country:US
Mailing Address - Phone:925-867-9500
Mailing Address - Fax:925-867-9559
Practice Address - Street 1:2570 SAN RAMON VALLEY BLVD
Practice Address - Street 2:SUITE A105
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1637
Practice Address - Country:US
Practice Address - Phone:925-867-9500
Practice Address - Fax:925-867-9559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXA0035920Medicaid
CA=========OtherTRICARE
CAXA0035920Medicaid