Provider Demographics
NPI:1639883713
Name:VILLARREAL, CARLOS EDUARDO (DNP-A, CRNA)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:EDUARDO
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:DNP-A, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 SABERCAT AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-3148
Mailing Address - Country:US
Mailing Address - Phone:956-457-1797
Mailing Address - Fax:
Practice Address - Street 1:2101 PEASE ST
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8307
Practice Address - Country:US
Practice Address - Phone:956-389-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1106973367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered