Provider Demographics
NPI:1043643679
Name:VILLARREAL, AARON (CRNA,NSPM-C)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:CRNA,NSPM-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6205 VIA SERENA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2664
Mailing Address - Country:US
Mailing Address - Phone:915-276-9075
Mailing Address - Fax:
Practice Address - Street 1:3851 E LOHMAN AVE. SUITE 4
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:575-205-0280
Practice Address - Fax:575-600-6010
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101281367500000X
NM54198367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty