Provider Demographics
NPI:1346751039
Name:VILLARREAL, SERGIO NMN (CFA)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:NMN
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 SAN ESTEBAN ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7509
Mailing Address - Country:US
Mailing Address - Phone:956-212-5951
Mailing Address - Fax:
Practice Address - Street 1:3505 SAN ESTEBAN ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-7509
Practice Address - Country:US
Practice Address - Phone:956-212-5951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16-296246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist