Provider Demographics
NPI:1033783923
Name:VILLEDA, SELVIN (MD)
Entity type:Individual
Prefix:
First Name:SELVIN
Middle Name:
Last Name:VILLEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2215 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-5228
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:611 N FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-1545
Practice Address - Country:US
Practice Address - Phone:806-725-5480
Practice Address - Fax:806-723-6156
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXV0572208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics