Healthcare Provider Details

I. General information

NPI: 1093992877
Provider Name (Legal Business Name): ROBERTO VILLEGAS, JR., M.D. PEDIATRICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 MCPHERSON RD SUITE 204
LAREDO TX
78045-6271
US

IV. Provider business mailing address

2320 MIDDLECOFF LN
LAREDO TX
78045-8159
US

V. Phone/Fax

Practice location:
  • Phone: 956-795-1440
  • Fax: 956-795-0092
Mailing address:
  • Phone: 956-795-1440
  • Fax: 956-795-0092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL5942
License Number StateTX

VIII. Authorized Official

Name: ROBERTO VILLEGAS JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 956-795-1440