Active NPI
Jose Luis Villa Jr., DDS
- Dentist
- San Jacinto, CA
National Provider Identifier
1063973949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 105604
- Practice address
- 2191 W Esplanade Ave Ste 106G
San Jacinto, CA 92582-3725 - Phone
- (951) 654-0080
- NPI assigned
- Mar 25, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 105604 | CA | Primary |
Addresses
Primary practice location
2191 W Esplanade Ave Ste 106G
San Jacinto, CA 92582-3725
Mailing address
10837 Anemone Cir
Moreno Valley, CA 92557-4114
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105604 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705622400000",
"number": "1063973949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10837 ANEMONE CIR",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925574114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2191 W ESPLANADE AVE STE 106G",
"city": "SAN JACINTO",
"state": "CA",
"postal_code": "925823725",
"telephone_number": "951-654-0080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VILLA",
"first_name": "JOSE",
"middle_name": "LUIS",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-03-25",
"last_updated": "2024-01-19",
"certification_date": "2024-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "105604",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jacinto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.