Individual provider Active NPI

Maureen Veronica Villasenor, MD

  • Pediatrics Physician
  • Los Angeles, CA
National Provider Identifier
1184923609
Registry record updated Nov 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A115452 Issued in CA
Practice address
4650 W Sunset Blvd
Mailstop #68
Los Angeles, CA 90027-6062
Phone
(323) 361-2122
NPI assigned
Mar 23, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A115452 CA Primary

Addresses

Primary practice location

4650 W Sunset Blvd
Mailstop #68
Los Angeles, CA 90027-6062

Mailing address

4650 W Sunset Blvd
Mailstop #68
Los Angeles, CA 90027-6062
Phone (323) 361-2122

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mvillasenor1373110@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120718000125 CA Practitioner - Pediatric Medicine 4789840893 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A115452CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Jan 19, 2015 Accepting new patients
Providence Medical Foundation CurrentSince Jan 19, 2015 Accepting new patients
Children'S Hospital Los Angeles Medical Group, Inc. Pediatrics CurrentSince Jul 1, 2012 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation Past Accepting new patients
St Joseph Hospital of Orange Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 400
Anaheim, CA 92805

1950 Sunny Crest Dr
Ste 2900
Fullerton, CA 92835

100 E Valencia Mesa Dr
#1051182
Fullerton, CA 92835
Phone (714) 446-5200

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

4650 W Sunset Blvd
#68
Los Angeles, CA 90027
Phone (323) 361-2122

4650 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 361-2122

2501 E Chapman Ave
Orange, CA 92869
Phone (714) 628-3300

2501 E Chapman Ave
Ste 104
Orange, CA 92869

1095 Irvine Blvd
Ste 404
Tustin, CA 92780

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: mvillasenor1373110@oc.providencedirect.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1300838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636588800000",
    "number": "1184923609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4650 W SUNSET BLVD",
            "address_2": "MAILSTOP #68",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276062",
            "telephone_number": "323-361-2122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 W SUNSET BLVD",
            "address_2": "MAILSTOP #68",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276062",
            "telephone_number": "323-361-2122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLASENOR",
        "first_name": "MAUREEN",
        "middle_name": "VERONICA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-23",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A115452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mvillasenor1373110@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1095 Irvine Blvd Ste 404",
            "city": "Tustin",
            "state": "CA",
            "country_code": "US",
            "postal_code": "927803526",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.