Provider Demographics
NPI:1063912913
Name:VILLARREAL, ANDREW (LVN)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10602 CANYON RIV
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-3983
Mailing Address - Country:US
Mailing Address - Phone:325-226-3131
Mailing Address - Fax:
Practice Address - Street 1:10602 CANYON RIV
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-3983
Practice Address - Country:US
Practice Address - Phone:325-226-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX337585164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse