Provider Demographics
NPI:1225035199
Name:VILLARREAL, SANTIAGO (MD)
Entity Type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4151 CALLAGHAN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-3419
Mailing Address - Country:US
Mailing Address - Phone:210-647-1195
Mailing Address - Fax:210-521-9473
Practice Address - Street 1:4151 CALLAGHAN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-3419
Practice Address - Country:US
Practice Address - Phone:210-647-1195
Practice Address - Fax:210-521-9473
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX8995207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B27326Medicare UPIN
00EJ26Medicare ID - Type Unspecified