Provider Demographics
NPI:1649580432
Name:VILLARREAL, BLANCA A (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:BLANCA
Middle Name:A
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7022
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78042-7022
Mailing Address - Country:US
Mailing Address - Phone:956-508-4279
Mailing Address - Fax:
Practice Address - Street 1:3210 LOOP 20
Practice Address - Street 2:SUITE 5
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-5009
Practice Address - Country:US
Practice Address - Phone:956-508-4279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80864133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered