Provider Demographics
NPI:1366455891
Name:VILLARREAL MD PA, ARMANDO
Entity Type:Individual
Prefix:
First Name:ARMANDO
Middle Name:
Last Name:VILLARREAL MD PA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 LIBERTY LN
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064-4711
Mailing Address - Country:US
Mailing Address - Phone:210-827-9272
Mailing Address - Fax:
Practice Address - Street 1:1540 W GOODWIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-3804
Practice Address - Country:US
Practice Address - Phone:830-569-6340
Practice Address - Fax:830-569-5165
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5734207Q00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXX0054580OtherDPS #
TX063660701Medicaid
TXAV2809107OtherDEA
TXB27335Medicare UPIN
TX063660701Medicaid