Provider Demographics
NPI:1659930634
Name:VILLA FAMILY CLINIC, PC
Entity Type:Organization
Organization Name:VILLA FAMILY CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VILLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DNP, APRN, FNP
Authorized Official - Phone:210-447-7961
Mailing Address - Street 1:11727 FABIANA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5659
Mailing Address - Country:US
Mailing Address - Phone:210-859-2531
Mailing Address - Fax:
Practice Address - Street 1:2000 SE LOOP 410 STE 127A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78220-4933
Practice Address - Country:US
Practice Address - Phone:210-447-7961
Practice Address - Fax:210-442-8973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty