Healthcare Provider Details

I. General information

NPI: 1932337516
Provider Name (Legal Business Name): BRIAN ALLEN VILLARREAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11398 BANDERA RD STE 201
SAN ANTONIO TX
78250-6827
US

IV. Provider business mailing address

16410 CALICO CREEK DR
SAN ANTONIO TX
78247-4443
US

V. Phone/Fax

Practice location:
  • Phone: 210-543-7334
  • Fax: 210-543-7338
Mailing address:
  • Phone: 210-823-0858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberFV3451832
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: