Provider Demographics
NPI:1639350457
Name:VILLAPANDO, MARIA DITAS
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DITAS
Last Name:VILLAPANDO
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 1:3805 PLANTATION GROVE BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6211
Mailing Address - Country:US
Mailing Address - Phone:956-519-4949
Mailing Address - Fax:
Practice Address - Street 1:3805 PLANTATION GROVE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6211
Practice Address - Country:US
Practice Address - Phone:956-519-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1098176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist