Provider Demographics
NPI:1689135444
Name:VILLEGAS, JESSIE ZEPEDA (LAC)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:ZEPEDA
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 W HILDEBRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-4667
Mailing Address - Country:US
Mailing Address - Phone:210-521-2100
Mailing Address - Fax:210-764-5541
Practice Address - Street 1:1039 W HILDEBRAND AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-4667
Practice Address - Country:US
Practice Address - Phone:210-521-2100
Practice Address - Fax:210-764-5541
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist