Healthcare Provider Details

I. General information

NPI: 1215016480
Provider Name (Legal Business Name): HECTOR RAUL VILLASENOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E QUINCY ST STE 427
SAN ANTONIO TX
78215-2033
US

IV. Provider business mailing address

215 E QUINCY ST STE 427
SAN ANTONIO TX
78215-2033
US

V. Phone/Fax

Practice location:
  • Phone: 210-223-7500
  • Fax: 210-223-9075
Mailing address:
  • Phone: 210-223-7500
  • Fax: 210-223-9075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberF3371
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: