Provider Demographics
NPI:1003146796
Name:VILLARREAL, JAVIER
Entity Type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 PORT ROYAL RD
Mailing Address - Street 2:
Mailing Address - City:PINGREE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-9196
Mailing Address - Country:US
Mailing Address - Phone:224-639-5017
Mailing Address - Fax:
Practice Address - Street 1:1122 PORT ROYAL RD
Practice Address - Street 2:
Practice Address - City:PINGREE GROVE
Practice Address - State:IL
Practice Address - Zip Code:60140-9196
Practice Address - Country:US
Practice Address - Phone:224-639-5017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-03
Last Update Date:2010-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter