MEDICARE: REBECCA ELIZABETH VILLARREAL PA-C

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	363A00000X	Physician Assistant	PA12721	TX
2	363AS0400X	Surgical Physician Assistant	PA12721	TX
3	363AM0700X	Medical Physician Assistant	PA12721	TX

General Provider Information

NPI Number	:	1528529328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA ELIZABETH VILLARREAL PA-C

Provider Business Mailing Address
First Line	:	PO BOX 659506
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78265-9506
Country	:	US
Telephone Number	:	210-878-4116
Fax Number	:	210-878-4113

Provider Business Practice Location Address
First Line	:	18626 HARDY OAK BLVD STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4218
Country	:	US
Telephone Number	:	210-878-4116
Fax Number	:

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

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	12/16/2025

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