Provider Demographics
NPI:1497925564
Name:E LINDA VILLARREAL MD PA
Entity Type:Organization
Organization Name:E LINDA VILLARREAL MD PA
Other - Org Name:MEMORIAL MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:E
Authorized Official - Middle Name:LINDA
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-381-5300
Mailing Address - Street 1:1501 S CLOSNER BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-5669
Mailing Address - Country:US
Mailing Address - Phone:956-381-5300
Mailing Address - Fax:956-316-4496
Practice Address - Street 1:1501 S CLOSNER BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5669
Practice Address - Country:US
Practice Address - Phone:956-381-5300
Practice Address - Fax:956-316-4496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5498207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135582100OtherVALLEY HEALTH PLANS
TX070002511OtherRAILROAD MEDICARE
TX084646101Medicaid
TX135582100OtherVALLEY HEALTH PLANS
TX070002511OtherRAILROAD MEDICARE