Healthcare Provider Details

I. General information

NPI: 1427679943
Provider Name (Legal Business Name): CESAR G VILLARREAL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4318 MOONLIGHT WAY
SAN ANTONIO TX
78230-5000
US

IV. Provider business mailing address

4318 MOONLIGHT WAY
SAN ANTONIO TX
78230-5000
US

V. Phone/Fax

Practice location:
  • Phone: 210-682-0140
  • Fax: 210-682-3238
Mailing address:
  • Phone: 210-682-0140
  • Fax: 210-682-3238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number38449
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: