Provider Demographics
NPI:1013501311
Name:VILLARREAL, ALYSSA N/A
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:N/A
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4092 TPC PKWY APT 443
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2922
Mailing Address - Country:US
Mailing Address - Phone:210-243-6865
Mailing Address - Fax:
Practice Address - Street 1:4092 TPC PKWY APT 443
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78261-2922
Practice Address - Country:US
Practice Address - Phone:210-243-6865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1023276164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse