Active NPI
Samantha Rebekah Villa, MS, ATC
- Athletic Trainer
- San Diego, CA
National Provider Identifier
1639402654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT001682
- Practice address
- 3117 30TH St
San Diego, CA 92104-4505 - Phone
- (619) 417-6451
- Fax
- (478) 301-2039
- NPI assigned
- Sep 9, 2009
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT001682 | GA | Primary |
Addresses
Primary practice location
3117 30TH St
San Diego, CA 92104-4505
Mailing address
3266 Nutmeg Street
Athletic Training Facility
San Diego, CA 92104
Phone (619) 282-2184
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT001682 | GA | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercer University School of Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Student in an Organized Health Care Education/Training Program
- Macon, GA
- NPI 1659705986
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1252454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612224000000",
"number": "1639402654",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3266 NUTMEG STREET",
"address_2": "ATHLETIC TRAINING FACILITY",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92104",
"telephone_number": "619-282-2184",
"fax_number": "619-282-1203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3117 30TH ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921044505",
"telephone_number": "619-417-6451",
"fax_number": "478-301-2039"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VILLA",
"first_name": "SAMANTHA",
"middle_name": "REBEKAH",
"credential": "MS, ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-09-09",
"last_updated": "2021-02-02",
"certification_date": "2021-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "GA",
"license": "AT001682",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.