Provider Demographics
NPI:1588776447
Name:VILLARINO, MIGUEL (MD)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:VILLARINO
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 1:4151 BOB BULLOCK LOOP
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-4741
Mailing Address - Country:US
Mailing Address - Phone:956-729-9738
Mailing Address - Fax:956-729-0291
Practice Address - Street 1:4151 BOB BULLOCK LOOP
Practice Address - Street 2:SUITE 103
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-4741
Practice Address - Country:US
Practice Address - Phone:956-729-9738
Practice Address - Fax:956-729-0291
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105857004Medicaid
TX105857003Medicaid
G55730Medicare UPIN
TX105857003Medicaid
TX105857004Medicaid
TX8F22047Medicare PIN