Healthcare Provider Details

I. General information

NPI: 1861199390
Provider Name (Legal Business Name): EMMA VILLEGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 02/15/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 CITY CENTRAL AVE
CONROE TX
77304-2981
US

IV. Provider business mailing address

76 TUBAC ST
PANORAMA VILLAGE TX
77304-1262
US

V. Phone/Fax

Practice location:
  • Phone: 936-202-5202
  • Fax: 936-202-5230
Mailing address:
  • Phone: 817-915-1678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: