Individual ProviderTish VillanuevaInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address4950 W Sunset Blvd, 2nd Floor, Los Angeles, CA 90027-5822(800) 954-8000PECOS EnrollmentBased on the most recent information from CMS, provider Tish Villanueva is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1891953915Provider TypeIndividualFull NameVillanueva, TishTitleDr.CredentialMDGenderFemaleSole ProprietorNoEnumeration Date5/27/2008Last Updated12/17/2021Contact InformationPractice LocationPractice Address4950 W Sunset Blvd, 2nd Floor, Los Angeles, CA 90027-5822Phone(800) 954-8000FaxUnlisted FaxMailing LocationMailing Address4950 W Sunset Blvd, 2nd Floor, Los Angeles, CA 90027-5822PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseA103957California