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General NPI Number Information
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NPI Number | 1659930634
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Entity Type | Organization
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Legal Business Name | VILLA FAMILY CLINIC, PC
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Dates
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Enumeration Date | 06/12/2019
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 2000 SE LOOP 410 STE 127A
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City | SAN ANTONIO
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State | TX
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Zip | 78220-4933
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Country | US
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Telephone | 210-447-7961
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Fax | 210-442-8973
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Provider Business Mailing Address
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Address Line | 11727 FABIANA
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City | SAN ANTONIO
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State | TX
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Zip | 78253-5659
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Country | US
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Telephone | 210-859-2531
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JOSE L VILLA JR.
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Credential | DNP, APRN, FNP
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Telephone | 210-447-7961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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