Provider Demographics
NPI:1164023784
Name:VILLAGRAN, DANIELLA
Entity Type:Individual
Prefix:DR
First Name:DANIELLA
Middle Name:
Last Name:VILLAGRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 LARIAT LOOP
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-3672
Mailing Address - Country:US
Mailing Address - Phone:956-763-4049
Mailing Address - Fax:
Practice Address - Street 1:5610 SAN BERNARDO AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3009
Practice Address - Country:US
Practice Address - Phone:956-723-1411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist