Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 036148655 | IL |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 2012018189 | MO |
N | 207YS0123X | Facial Plastic Surgeon | 036148655 | IL |
NPI | 1437413945 |
---|---|
Provider Name | Dr. Peter Michael Vila |
First Address | San Rafael, CA 94903-3664 |
Second Address | San Rafael, CA 94903-3664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2012 |
Last Update Date | 02/03/2021 |