Provider Demographics
NPI:1144226457
Name:VILLANUEVA, JAVIER G (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:G
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 JOHN SMITH STE 214
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6000
Mailing Address - Country:US
Mailing Address - Phone:210-849-1244
Mailing Address - Fax:210-691-0111
Practice Address - Street 1:7410 JOHN SMITH
Practice Address - Street 2:STE 214
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6000
Practice Address - Country:US
Practice Address - Phone:210-849-1244
Practice Address - Fax:210-691-0111
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31920103T00000X
CO2598103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0049JNMedicare UPIN
TX00385HMedicare ID - Type UnspecifiedMEDICARE ACCOUNT NUMBER