Provider Demographics
NPI:1952481293
Name:VILLARREAL, GRACIELA (MD)
Entity Type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 N STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1829
Mailing Address - Country:US
Mailing Address - Phone:832-822-3400
Mailing Address - Fax:832-825-3399
Practice Address - Street 1:8080 N STADIUM DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1829
Practice Address - Country:US
Practice Address - Phone:832-822-3400
Practice Address - Fax:832-825-3399
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7041208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138736706Medicaid
8386J0Medicare ID - Type Unspecified
TX138736706Medicaid