Healthcare Provider Details

I. General information

NPI: 1104847342
Provider Name (Legal Business Name): GERARDO VILLARREAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA MEDICAL CENTER 2100 RIDGECREST SE
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax:
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number97-399
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: