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General NPI Number Information
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NPI Number | 1154302008
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Entity Type | Organization
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Legal Business Name | JOSE J VILLARREAL
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 10/30/2018
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Provider Practice Location Address
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Address Line | 200 N HAMMES AVE
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City | JOLIET
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State | IL
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Zip | 60435-6677
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Country | US
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Telephone | 815-744-6622
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Fax | 815-744-9585
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Provider Business Mailing Address
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Address Line | PO BOX 967
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City | TINLEY PARK
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State | IL
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Zip | 60477-0967
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Country | US
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Telephone | 708-532-6029
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Fax | 708-468-4991
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Authorized Official
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Title or Position | OFFICER
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Name | DR. JOSE J VILLARREAL
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Credential | MD
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Telephone | 708-774-2970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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