Provider Demographics
NPI:1104930304
Name:VILLARREAL, ROSENDO (LSA , OPA-C)
Entity type:Individual
Prefix:MR
First Name:ROSENDO
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:LSA , OPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 BAKER RD UNIT 251
Mailing Address - Street 2:
Mailing Address - City:BARKER
Mailing Address - State:TX
Mailing Address - Zip Code:77413-6013
Mailing Address - Country:US
Mailing Address - Phone:281-468-1212
Mailing Address - Fax:
Practice Address - Street 1:211 BAKER RD UNIT 251
Practice Address - Street 2:
Practice Address - City:BARKER
Practice Address - State:TX
Practice Address - Zip Code:77413-6013
Practice Address - Country:US
Practice Address - Phone:281-468-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00249OtherTX SURGICAL ASSISTANT