Provider Demographics
NPI:1114023488
Name:JOSE LUIS VILLARREAL, MD, PA
Entity Type:Organization
Organization Name:JOSE LUIS VILLARREAL, MD, PA
Other - Org Name:PAIN & SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-351-1155
Mailing Address - Street 1:5652 N MESA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5425
Mailing Address - Country:US
Mailing Address - Phone:915-351-1155
Mailing Address - Fax:915-351-1230
Practice Address - Street 1:5652 N MESA
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5425
Practice Address - Country:US
Practice Address - Phone:915-351-1155
Practice Address - Fax:915-351-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00132ZMedicare PIN
TXF83015Medicare UPIN