Healthcare Provider Details

I. General information

NPI: 1811923824
Provider Name (Legal Business Name): JOSH VILLASENOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSUE VILLASENOR AUDIO PROSTHOLOGIST

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 GATEWAY BOULEVARD LIBERTY HEARING AID CENTER
EL PASO TX
79925
US

IV. Provider business mailing address

1562 WESTBROOK AVE
ODESSA TX
79761-1838
US

V. Phone/Fax

Practice location:
  • Phone: 915-771-7896
  • Fax:
Mailing address:
  • Phone: 432-254-1251
  • Fax: 432-296-6605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number50120
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: