Provider Demographics
NPI:1235318858
Name:VILLARREAL, SALLY SUITER (MD)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:SUITER
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 LINDBERG AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2928
Mailing Address - Country:US
Mailing Address - Phone:956-682-8800
Mailing Address - Fax:956-682-9464
Practice Address - Street 1:712 LINDBERG AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2928
Practice Address - Country:US
Practice Address - Phone:956-682-8800
Practice Address - Fax:956-682-9464
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4812208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH90194OtherUPIN