Provider Demographics
NPI:1265458491
Name:VILLAREAL, REINA C (MD)
Entity Type:Individual
Prefix:DR
First Name:REINA
Middle Name:C
Last Name:VILLAREAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8127
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-454-7775
Mailing Address - Fax:314-362-3454
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:5TH FLOOR
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-454-7775
Practice Address - Fax:314-362-3454
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO103744207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204758908Medicaid
IL$$$$$$$$$Medicaid
MO204758908Medicaid
295010183Medicare PIN
460002766Medicare PIN