MEDICARE: JAVIER R. VILLARREAL CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	626943	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	85322U	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1063498988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVIER R. VILLARREAL CRNA

Provider Business Mailing Address
First Line	:	906 W MCDERMOTT DR # 116-371
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-6510
Country	:	US
Telephone Number	:	469-541-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4510 MEDICAL CENTER DR STE 211
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75069-1602
Country	:	US
Telephone Number	:	469-541-1600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	09/28/2023

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