=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841142684
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. YOSHIO IVAN VILLARREAL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2026
-----------------------------------------------------
Last Update Date | 02/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4501 W EXPRESSWAY 83
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78503-0029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-321-9740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4516 CARROL RD
-----------------------------------------------------
City | MISSION
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78574-0415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-321-9740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | AT10346
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------