Provider Demographics
NPI:1811157571
Name:VILLEGAS, SERGIO ANDRES (MD)
Entity type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:ANDRES
Last Name:VILLEGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1710 E SAUNDERS ST # B440
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5443
Mailing Address - Country:US
Mailing Address - Phone:956-267-8146
Mailing Address - Fax:956-267-8147
Practice Address - Street 1:1710 E SAUNDERS ST # B440
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5443
Practice Address - Country:US
Practice Address - Phone:956-267-8146
Practice Address - Fax:956-267-8147
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112696207Q00000X
TXP0151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286417501Medicaid