Individual
DIANA DEROSA VILLARREAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11175 CAMPUS ST, DEPARTMENT OF PEDIATRICS, LOMA LINDA, CA 92350-1700
(909) 558-8142
(909) 558-5981
Mailing address
11175 CAMPUS ST, DEPARTMENT OF PEDIATRICS, LOMA LINDA, CA 92350-1700
(909) 558-8142
(909) 558-5981
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A161918
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000169885
—
CO
Enumeration date
04/14/2015
Last updated
11/29/2021
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