Provider Demographics
NPI:1164875902
Name:GONZALEZ VILLALBA, JOSE ADOLFO (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ADOLFO
Last Name:GONZALEZ VILLALBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16620 SAN PEDRO AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2679
Mailing Address - Country:US
Mailing Address - Phone:210-871-4701
Mailing Address - Fax:210-688-4596
Practice Address - Street 1:16620 SAN PEDRO AVE STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2679
Practice Address - Country:US
Practice Address - Phone:210-871-4701
Practice Address - Fax:210-688-4596
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC86507207R00000X
MDD0091283208M00000X
CODR.0062854208M00000X
TXU1019207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX466021901Medicaid
SCSCL150H888OtherMEDICARE PIN