Provider Demographics
NPI:1619996436
Name:VILLARREAL, JOSE S (DO)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:S
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 45TH STREET
Mailing Address - Street 2:SUITE CL149
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2413
Mailing Address - Country:US
Mailing Address - Phone:561-882-4541
Mailing Address - Fax:561-650-6093
Practice Address - Street 1:901 45TH STREET
Practice Address - Street 2:SUITE CL149
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2413
Practice Address - Country:US
Practice Address - Phone:561-882-4541
Practice Address - Fax:561-650-6093
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10951208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00447210OtherRAILROAD MEDICARE PIN
FL008227000Medicaid
TX8X7293OtherBCBS
TX185047101Medicaid
TXI62035Medicare UPIN
FL008227000Medicaid