Healthcare Provider Details

I. General information

NPI: 1609873371
Provider Name (Legal Business Name): RICARDO DEJESUS VILLAFANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12315 JUDSON RD STE 110
LIVE OAK TX
78233-3263
US

IV. Provider business mailing address

12315 JUDSON RD STE 110
LIVE OAK TX
78233-3263
US

V. Phone/Fax

Practice location:
  • Phone: 210-304-3500
  • Fax: 210-337-2909
Mailing address:
  • Phone: 210-566-8332
  • Fax: 210-682-9151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG5733
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: