Provider Demographics
NPI:1245658269
Name:VILLARREAL, JUAN MIGUEL (PA-C)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:MIGUEL
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-787-5454
Mailing Address - Fax:956-787-5486
Practice Address - Street 1:1229 S VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589
Practice Address - Country:US
Practice Address - Phone:956-787-5454
Practice Address - Fax:956-787-5486
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant