Provider Demographics
NPI:1376869784
Name:VILLARREAL, NYRIA CAROLINA (MD)
Entity Type:Individual
Prefix:DR
First Name:NYRIA
Middle Name:CAROLINA
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7250 CLEARVISTA DR
Practice Address - Street 2:SUITE 260
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256
Practice Address - Country:US
Practice Address - Phone:317-621-1690
Practice Address - Fax:317-621-1699
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059578A207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01009908OtherRR MEDICARE PTAN
INP01214603OtherRR MEDICARE PTAN
IN200521140Medicaid
INP01009908OtherRR MEDICARE PTAN
IN200521140Medicaid