Provider Demographics
NPI:1104631878
Name:VILLAGRAN, ELISA
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:VILLAGRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8610 REDSTONE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-3684
Mailing Address - Country:US
Mailing Address - Phone:915-637-3161
Mailing Address - Fax:
Practice Address - Street 1:8610 REDSTONE HILLS DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-3684
Practice Address - Country:US
Practice Address - Phone:915-637-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider