Healthcare Provider Details

I. General information

NPI: 1144159336
Provider Name (Legal Business Name): MEDICAL NEUROPYCHOLOGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 POLK ST
EUGENE OR
97402-3959
US

IV. Provider business mailing address

1275 POLK ST
EUGENE OR
97402-3959
US

V. Phone/Fax

Practice location:
  • Phone: 786-503-0203
  • Fax:
Mailing address:
  • Phone: 786-503-0203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PROF. CARLOS ANTONIO VILLARREAL SR.
Title or Position: NEUROLOGY
Credential: PHD MD
Phone: 786-503-0203