Provider Demographics
NPI:1093299026
Name:VILLEGAS, MARIO CESAR (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:CESAR
Last Name:VILLEGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1503 SIOUX DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-2126
Mailing Address - Country:US
Mailing Address - Phone:915-383-1197
Mailing Address - Fax:915-207-1855
Practice Address - Street 1:CALLE IGNACIO MEJIA #1913
Practice Address - Street 2:
Practice Address - City:CIUDAD JUAREZ
Practice Address - State:CHIHUAHUA
Practice Address - Zip Code:32030
Practice Address - Country:MX
Practice Address - Phone:915-383-1198
Practice Address - Fax:915-207-1855
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-15
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ7425126208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice