Healthcare Provider Details

I. General information

NPI: 1497930044
Provider Name (Legal Business Name): SEBASTIAN VILLARREAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24608 KINGSLAND BLVD
KATY TX
77494-3386
US

IV. Provider business mailing address

PO BOX 571688
HOUSTON TX
77257-1688
US

V. Phone/Fax

Practice location:
  • Phone: 281-665-8552
  • Fax: 281-665-8559
Mailing address:
  • Phone: 713-622-1700
  • Fax: 713-877-0672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberN5462
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: