Healthcare Provider Details

I. General information

NPI: 1043643679
Provider Name (Legal Business Name): AARON VILLARREAL CRNA,NSPM-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 E LOHMAN AVE. SUITE 4
LAS CRUCES NM
88011
US

IV. Provider business mailing address

6205 VIA SERENA DR
EL PASO TX
79912-2664
US

V. Phone/Fax

Practice location:
  • Phone: 575-205-0280
  • Fax: 575-600-6010
Mailing address:
  • Phone: 915-276-9075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101281
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number54198
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: