Healthcare Provider Details

I. General information

NPI: 1659901908
Provider Name (Legal Business Name): LUIS VILLARREAL MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 DANUBIO STE C
BROWNSVILLE TX
78526-8439
US

IV. Provider business mailing address

9128 LAKE CHARLES DR
LOS FRESNOS TX
78566-4706
US

V. Phone/Fax

Practice location:
  • Phone: 956-372-2932
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number15229
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: