Provider Demographics
NPI:1700148855
Name:VILLAGOMEZ, EVANGELINA TREJO (PHD, APRN, CS, CDE)
Entity Type:Individual
Prefix:DR
First Name:EVANGELINA
Middle Name:TREJO
Last Name:VILLAGOMEZ
Suffix:
Gender:F
Credentials:PHD, APRN, CS, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9706 BOB WHITE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-3730
Mailing Address - Country:US
Mailing Address - Phone:281-660-7605
Mailing Address - Fax:
Practice Address - Street 1:325 W 20TH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2436
Practice Address - Country:US
Practice Address - Phone:713-868-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX505248364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical