Individual
MR. JOSE L VILLAGOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12099 W WASHINGTON BLVD STE 400, LOS ANGELES, CA 90066-2620
(310) 398-3803
(310) 398-5189
Mailing address
12099 W WASHINGTON BLVD STE 400, LOS ANGELES, CA 90066-2620
(310) 398-3803
(310) 398-5189
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A61283
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A612830
MEDICAL
CA
05
—
00A612830
—
CA
01
—
11613705
CAQH
—
Enumeration date
06/13/2006
Last updated
09/11/2025
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