Healthcare Provider Details

I. General information

NPI: 1225035199
Provider Name (Legal Business Name): SANTIAGO VILLARREAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4151 CALLAGHAN RD SUITE 103
SAN ANTONIO TX
78228-3419
US

IV. Provider business mailing address

4151 CALLAGHAN RD SUITE 103
SAN ANTONIO TX
78228-3419
US

V. Phone/Fax

Practice location:
  • Phone: 210-647-1195
  • Fax: 210-521-9473
Mailing address:
  • Phone: 210-647-1195
  • Fax: 210-521-9473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberTX8995
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: