MEDICARE: ALEXIS DIANE VILLARREAL HIS

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	237700000X	Hearing Instrument Specialist	80774	TX

General Provider Information

NPI Number	:	1871023705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS DIANE VILLARREAL HIS

Provider Business Mailing Address
First Line	:	4335 COLLEGE HILLS BLVD
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-6919
Country	:	US
Telephone Number	:	325-949-8351
Fax Number	:	325-944-2958

Provider Business Practice Location Address
First Line	:	4335 COLLEGE HILLS BLVD
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-6919
Country	:	US
Telephone Number	:	325-949-8351
Fax Number	:	325-944-2958

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

Provider Enumeration Date	:	06/13/2017
Last Update Date	:	07/21/2022

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