Healthcare Provider Details

I. General information

NPI: 1750184776
Provider Name (Legal Business Name): DR. CARLOS ANTONIO VILLARREAL PINTO SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. CARLOS ANTONIO VILLARREAL SR.

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 04/05/2025
Certification Date: 04/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 5 OESTE VIA ESTUDIANTE 77
VOLCAN TIERRAS ALTAS CHIRIQUI
40424
PA

IV. Provider business mailing address

CALLE 5 OESTE VIA ESTUDIANTE 77
VOLCAN TIERRAS ALTAS CHIRIQUI
40424
PA

V. Phone/Fax

Practice location:
  • Phone: 541-246-9023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1143
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number1153
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number1142
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: