Healthcare Provider Details

I. General information

NPI: 1285643916
Provider Name (Legal Business Name): JAVIER VILLANUEVA-MEYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 FROSTWOOD DR STE 275
HOUSTON TX
77024-2420
US

IV. Provider business mailing address

301 UNIVERSITY BLVD
GALVESTON TX
77555-5302
US

V. Phone/Fax

Practice location:
  • Phone: 713-461-3573
  • Fax:
Mailing address:
  • Phone: 409-772-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberJ3256
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: