Provider Demographics
NPI:1578973442
Name:VILLAGOMEZ, MARIA DEL CARMEN
Entity Type:Individual
Prefix:
First Name:MARIA DEL CARMEN
Middle Name:
Last Name:VILLAGOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 335
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2256
Mailing Address - Country:US
Mailing Address - Phone:972-254-6022
Mailing Address - Fax:972-253-3242
Practice Address - Street 1:2001 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 335
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2256
Practice Address - Country:US
Practice Address - Phone:972-254-6022
Practice Address - Fax:972-253-3242
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily