MEDICARE: VERONICA VILLALBA M.D

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	207V00000X	Obstetrics & Gynecology Physician	L5170	TX
2	207V00000X	Obstetrics & Gynecology Physician	L5170	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L5170	OTHER	TX	MEDICAL LICENSE #

General Provider Information

NPI Number	:	1679533855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONICA VILLALBA M.D

Provider Business Mailing Address
First Line	:	PO BOX 961205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-0205
Country	:	US
Telephone Number	:	817-740-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	6750 N MACARTHUR BLVD
Second Line	:	SUITE 207
City	:	IRVING
State	:	TX
Zip	:	75039-2875
Country	:	US
Telephone Number	:	972-444-8423
Fax Number	:	972-444-8338

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	04/13/2021

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Directions to “ VERONICA VILLALBA M.D” Practice Location

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