Mark Angelo Villegas, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

62879 Issued in CA

Practice address

1014 N Broadway
Santa Ana, CA 92701-3408

Phone

(949) 270-2100

NPI assigned

Jun 14, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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

• Share Our Selves Corporation

  dba Share Our Selves Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Costa Mesa, CA
  • NPI 1508073685
  Medicare reassignment
• Share Our Selves Corporation

  dba Share Our Selves Pharmacy

  • Federally Qualified Health Center (FQHC)
  • Costa Mesa, CA
  • NPI 1144717778
  NPD
• Share Our Selves Corporation

  • Federally Qualified Health Center (FQHC)
  • Costa Mesa, CA
  • NPI 1669258612
  NPD

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

{
    "created_epoch": "1686700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1629752985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 SUNSET DR",
            "city": "HOLLISTER",
            "state": "CA",
            "postal_code": "950235606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 N BROADWAY",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927013408",
            "telephone_number": "949-270-2100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "911 Sunset Dr",
            "address_purpose": "LOCATION",
            "city": "Hollister",
            "state": "CA",
            "postal_code": "950235606",
            "country_code": "US",
            "telephone_number": "831-623-4615",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VILLEGAS",
        "first_name": "MARK ANGELO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-14",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "62879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT LICENSE",
            "identifier": "62879",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sabrina Villatoro
• Gisela Maria Obieta Villavicencio, LCSW
• Ruby Villavisencio, MSN, CPNP
• Laura E. Villegas Perdomo, LPT
• Lyvia Mendoza Villegas, NURSE PRACTITIONER
• Vanessa Villegas
• Lisa Villela, RN
• Anna Villet
• Maegan Viloria
• Vina D. Tran, D.D.S., Inc

• Physician Assistant in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.