MEDICARE: LUIS FEDERICO VILLARREAL MD

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	207Q00000X	Family Medicine Physician	L8549	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

General Provider Information

NPI Number	:	1538156401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS FEDERICO VILLARREAL MD

Provider Business Mailing Address
First Line	:	4619 SAN DARIO AVE # 310
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-5773
Country	:	US
Telephone Number	:	956-753-3901
Fax Number	:	956-753-3434

Provider Business Practice Location Address
First Line	:	6930 SPRINGFIELD AVE
Second Line	:	SUITE 2
City	:	LAREDO
State	:	TX
Zip	:	78041-2312
Country	:	US
Telephone Number	:	956-753-3901
Fax Number	:	956-753-3434

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	08/21/2008

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