Healthcare Provider Details

I. General information

NPI: 1861132961
Provider Name (Legal Business Name): MADELYN KATE VILLARREAL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 E LEAGUE CITY PKWY STE 200
LEAGUE CITY TX
77573-2100
US

IV. Provider business mailing address

424 HAHLO ST
HOUSTON TX
77020-3022
US

V. Phone/Fax

Practice location:
  • Phone: 281-523-3110
  • Fax:
Mailing address:
  • Phone: 713-674-3326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberV2847
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: