Provider Demographics
NPI:1114038759
Name:VILLARREAL, JUAN A (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:A
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J.
Other - Middle Name:A
Other - Last Name:VILLARREAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:13725 NORTHWEST BLVD
Mailing Address - Street 2:SUITE #110
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5127
Mailing Address - Country:US
Mailing Address - Phone:361-387-7177
Mailing Address - Fax:361-387-8355
Practice Address - Street 1:13725 NORTHWEST BLVD
Practice Address - Street 2:SUITE #110
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5127
Practice Address - Country:US
Practice Address - Phone:361-387-7177
Practice Address - Fax:361-387-8355
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3292207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116026902Medicaid
TX116026902Medicaid
F60495Medicare UPIN