Provider Demographics
NPI:1063498988
Name:VILLARREAL, JAVIER R (CRNA)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:R
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 W MCDERMOTT DR # 116-371
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6510
Mailing Address - Country:US
Mailing Address - Phone:469-541-1600
Mailing Address - Fax:
Practice Address - Street 1:4510 MEDICAL CENTER DR STE 211
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1602
Practice Address - Country:US
Practice Address - Phone:469-541-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX626943367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200416020AMedicaid
TX161070107Medicaid
TX161070102Medicaid
TX161070104Medicaid
TX161070106Medicaid
TX85322UOtherBCBS
TX161070106Medicaid
TX8D7451Medicare PIN
TX161070102Medicaid
TX85322UOtherBCBS
OK200416020AMedicaid