Provider Demographics
NPI:1104033174
Name:VILLARREAL MEDICAL CLINIC PA
Entity Type:Organization
Organization Name:VILLARREAL MEDICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:ROMEO
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-631-7117
Mailing Address - Street 1:1200 S 2ND ST. STE.A3
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2997
Mailing Address - Country:US
Mailing Address - Phone:956-631-7117
Mailing Address - Fax:956-631-7134
Practice Address - Street 1:1200 S 2ND ST. STE.A3
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2997
Practice Address - Country:US
Practice Address - Phone:956-631-7117
Practice Address - Fax:956-631-7134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0342174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTX ID #