Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A121521 | CA |
N | 207QA0505X | Family Doctor - Adult Medicine | A121521 | CA |
NPI | 1215166640 |
---|---|
Provider Name | Dr. Elizabeth E. Villarico |
First Address | Modesto, CA 95356 |
Second Address | Modesto, CA 95356-8627 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2009 |
Last Update Date | 11/02/2022 |