=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043643679
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AARON VILLARREAL CRNA,NSPM-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2013
-----------------------------------------------------
Last Update Date | 11/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3851 E LOHMAN AVE. SUITE 4
-----------------------------------------------------
City | LAS CRUCES
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-205-0280
-----------------------------------------------------
Fax | 575-600-6010
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6205 VIA SERENA DR
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79912-2664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-276-9075
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 101281
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 54198
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------