Provider Demographics
NPI:1336563097
Name:VILLARREAL, SONIA (PA-C)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:SONIA
Other - Middle Name:
Other - Last Name:VILLARREAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:4642 GREEN WILLOW WOODS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-1432
Mailing Address - Country:US
Mailing Address - Phone:210-269-3199
Mailing Address - Fax:
Practice Address - Street 1:4203 E SOUTHCROSS BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-3722
Practice Address - Country:US
Practice Address - Phone:210-222-0333
Practice Address - Fax:210-928-4837
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-14
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08888363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX339059301Medicaid
TX339059301Medicaid