Provider Demographics
NPI:1063738961
Name:ROBERTO L. VILLARREAL MDPA
Entity type:Organization
Organization Name:ROBERTO L. VILLARREAL MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:MDPA
Authorized Official - Phone:956-717-5974
Mailing Address - Street 1:6553 METRO COURT
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041
Mailing Address - Country:US
Mailing Address - Phone:956-717-5974
Mailing Address - Fax:956-791-0736
Practice Address - Street 1:6553 METRO COURT
Practice Address - Street 2:SUITE A
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-717-5974
Practice Address - Fax:956-791-0736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF33702080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130196201Medicaid
TX130196202Medicaid
TXB27328Medicare UPIN
TX130196202Medicaid