Provider Demographics
NPI:1659367647
Name:VILLA, RUBEN DARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:DARIO
Last Name:VILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5424 19TH ST STE 403
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-2162
Mailing Address - Country:US
Mailing Address - Phone:063-688-7828
Mailing Address - Fax:806-367-8361
Practice Address - Street 1:5424 19TH ST # 403
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2162
Practice Address - Country:US
Practice Address - Phone:806-368-8782
Practice Address - Fax:806-368-8361
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0958174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH76052Medicare UPIN
NM343534100Medicare PIN
TX8D5919Medicare ID - Type Unspecified
TX8D5919Medicare PIN