Provider Demographics
NPI:1780046839
Name:NARDINI, JOHANNA VILLASENOR (MD)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:VILLASENOR
Last Name:NARDINI
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 1:13423 BLANCO RD UNIT 3164
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2187
Mailing Address - Country:US
Mailing Address - Phone:201-210-2656
Mailing Address - Fax:
Practice Address - Street 1:114 W 7TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-3000
Practice Address - Country:US
Practice Address - Phone:956-465-0420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-27
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD614139902084P0800X, 2084P0804X
TXT01152084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry