Provider Demographics
NPI:1295796175
Name:VILLARREAL, ROBERTO LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:LUIS
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6553 METRO CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-9137
Mailing Address - Country:US
Mailing Address - Phone:956-717-5974
Mailing Address - Fax:956-791-0736
Practice Address - Street 1:6553 METRO CT
Practice Address - Street 2:SUITE A
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-9137
Practice Address - Country:US
Practice Address - Phone:956-717-5974
Practice Address - Fax:956-791-0736
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF33702080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00EU79OtherBLUE CROSS BLUE SHIELD ID
TX130196201Medicaid
TX130196201Medicaid
TX742317628OtherTAX ID NUMBER
TX130196201Medicaid