Healthcare Provider Details

I. General information

NPI: 1962818385
Provider Name (Legal Business Name): KATY PAIN SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24608 KINGSLAND BLVD
KATY TX
77494-9998
US

IV. Provider business mailing address

24608 KINGSLAND BLVD
KATY TX
77494-9998
US

V. Phone/Fax

Practice location:
  • Phone: 281-665-8552
  • Fax: 281-665-8559
Mailing address:
  • Phone: 281-665-8552
  • Fax: 281-665-8559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberN5462
License Number StateTX

VIII. Authorized Official

Name: DR. SEBASTIAN VILLARREAL
Title or Position: PRESIDENT
Credential: MD
Phone: 281-665-8552