Provider Demographics
NPI:1093276743
Name:VILLARREAL, MANUEL URBANO
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:URBANO
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 1:529 S JEFFERSON ST STE 203
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-4125
Mailing Address - Country:US
Mailing Address - Phone:920-360-6568
Mailing Address - Fax:
Practice Address - Street 1:529 S JEFFERSON ST STE 203
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4125
Practice Address - Country:US
Practice Address - Phone:920-360-6568
Practice Address - Fax:920-482-5703
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty