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General NPI Number Information
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NPI Number | 1962180661
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Entity Type | Individual
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Provider Name | JESUS MANUEL VILLARREAL
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Gender | Male
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 10105 WOLVERINE DR
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City | EL PASO
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State | TX
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Zip | 79924-4311
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Country | US
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Telephone | 915-329-9131
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Fax |
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Provider Business Mailing Address
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Address Line | 401 PRIME DESERT DR
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City | EL PASO
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State | TX
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Zip | 79932-2146
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Country | US
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Telephone | 915-329-9131
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Fax |
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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 | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State | TX
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