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General NPI Number Information
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NPI Number | 1659367647
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Entity Type | Individual
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Provider Name | RUBEN DARIO VILLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 5424 19TH ST # 403
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City | LUBBOCK
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State | TX
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Zip | 79407-2162
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Country | US
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Telephone | 806-368-8782
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Fax | 806-368-8361
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Provider Business Mailing Address
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Address Line | 5424 19TH ST STE 403
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City | LUBBOCK
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State | TX
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Zip | 79407-2162
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Country | US
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Telephone | 63-688-7828
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Fax | 806-367-8361
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | M0958
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | M0958
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License Number State | TX
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