Provider Demographics
NPI:1144735580
Name:VILLATORO, MARIA JOSE (LSA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:JOSE
Last Name:VILLATORO
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1156
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77410
Mailing Address - Country:US
Mailing Address - Phone:832-812-8342
Mailing Address - Fax:
Practice Address - Street 1:17914 DOVETAIL CREEK CT
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-7208
Practice Address - Country:US
Practice Address - Phone:832-812-8342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17-102208600000X
363AS0400X
TXSA00788363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No208600000XAllopathic & Osteopathic PhysiciansSurgery