Healthcare Provider Details

I. General information

NPI: 1427767797
Provider Name (Legal Business Name): BRENDA GUADALUPE VILLARREAL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 ISOM RD
SAN ANTONIO TX
78216-4464
US

IV. Provider business mailing address

622 ISOM RD
SAN ANTONIO TX
78216-4464
US

V. Phone/Fax

Practice location:
  • Phone: 210-622-8000
  • Fax:
Mailing address:
  • Phone: 210-622-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1097772
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: