Provider Demographics
NPI:1831431527
Name:VILLARREAL, NORMA ALICIA (MD)
Entity type:Individual
Prefix:DR
First Name:NORMA
Middle Name:ALICIA
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NORMA
Other - Middle Name:ALICIA
Other - Last Name:CADENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:22D MEDICAL GROUP
Mailing Address - Street 2:57950 LEAVENWORTH ST
Mailing Address - City:MCCONNELL AFB
Mailing Address - State:KS
Mailing Address - Zip Code:67221-3506
Mailing Address - Country:US
Mailing Address - Phone:316-759-5050
Mailing Address - Fax:316-759-6277
Practice Address - Street 1:22D MEDICAL GROUP
Practice Address - Street 2:57950 LEAVENWORTH ST
Practice Address - City:MCCONNELL AFB
Practice Address - State:KS
Practice Address - Zip Code:67221-3506
Practice Address - Country:US
Practice Address - Phone:316-759-5050
Practice Address - Fax:316-759-6277
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ73726207Q00000X
WAMD61033581207Q00000X
CA138469207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty