Provider Demographics
NPI:1679533855
Name:VILLALBA, VERONICA (MD)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:VILLALBA
Suffix:
Gender:F
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:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-0205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:
Practice Address - Street 1:6750 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2875
Practice Address - Country:US
Practice Address - Phone:972-444-8423
Practice Address - Fax:972-444-8338
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5170207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL5170OtherMEDICAL LICENSE #
TXH70958Medicare UPIN
TXL5170OtherMEDICAL LICENSE #