Provider Demographics
NPI:1427679943
Name:VILLARREAL, CESAR G (PHD)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:G
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 MOONLIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5000
Mailing Address - Country:US
Mailing Address - Phone:210-682-0140
Mailing Address - Fax:210-682-3238
Practice Address - Street 1:4318 MOONLIGHT WAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5000
Practice Address - Country:US
Practice Address - Phone:210-682-0140
Practice Address - Fax:210-682-3238
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38449103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX38449OtherMEDICAL LICENSE