Provider Demographics
NPI:1003316092
Name:VILLARREAL, MARIA LETICIA
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:LETICIA
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 NESSUH AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-4814
Mailing Address - Country:US
Mailing Address - Phone:956-630-1116
Mailing Address - Fax:877-626-0431
Practice Address - Street 1:1601 CYPRESS DR
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78599-3880
Practice Address - Country:US
Practice Address - Phone:956-624-2816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX811716163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse