MEDICARE: SELENA MARIE VILLARREAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA18976	TX

General Provider Information

NPI Number	:	1215665591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELENA MARIE VILLARREAL

Provider Business Mailing Address
First Line	:	1201 W UNIVERSITY DR
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-2909
Country	:	US
Telephone Number	:	956-665-7049
Fax Number	:

Provider Business Practice Location Address
First Line	:	12047 POTRANCO RD STE 105
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-7555
Country	:	US
Telephone Number	:	210-571-1338
Fax Number	:	210-571-1339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2022
Last Update Date	:	04/01/2025

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Directions to “ SELENA MARIE VILLARREAL ” Practice Location

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