Provider Demographics
NPI:1134411473
Name:DIANA VILLARREAL, M.D., P.A.
Entity type:Organization
Organization Name:DIANA VILLARREAL, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-762-0177
Mailing Address - Street 1:1917 BROADWAY ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-8723
Mailing Address - Country:US
Mailing Address - Phone:409-762-0177
Mailing Address - Fax:
Practice Address - Street 1:1917 BROADWAY ST
Practice Address - Street 2:SUITE 2
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-8723
Practice Address - Country:US
Practice Address - Phone:409-762-0177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXGO239261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health