Provider Demographics
NPI:1104882992
Name:VILLAFANI, JUAN MARIO (MD FACS)
Entity type:Individual
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First Name:JUAN
Middle Name:MARIO
Last Name:VILLAFANI
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Gender:M
Credentials:MD FACS
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Mailing Address - Street 1:22710 PROFESSIONAL DR
Mailing Address - Street 2:STE 102
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-6008
Mailing Address - Country:US
Mailing Address - Phone:281-548-3555
Mailing Address - Fax:281-548-3552
Practice Address - Street 1:19701 KINGWOOD DR
Practice Address - Street 2:BLDG 9
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3773
Practice Address - Country:US
Practice Address - Phone:281-548-3555
Practice Address - Fax:281-548-3552
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2017-04-26
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Provider Licenses
StateLicense IDTaxonomies
TXJ9930208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0019BYOtherGROUP MEDICARE PTAN
TX036316004Medicaid
TX111815002OtherGROUP TPI- MILLENNIUM PHYSICIANS ASSOCIATION, PLLC
TX1255397733OtherGROUP NPI
TX1255397733OtherGROUP NPI