Provider Demographics
NPI:1538156401
Name:VILLARREAL, LUIS FEDERICO (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:FEDERICO
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 SAN DARIO AVE # 310
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5773
Mailing Address - Country:US
Mailing Address - Phone:956-753-3901
Mailing Address - Fax:956-753-3434
Practice Address - Street 1:6930 SPRINGFIELD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2312
Practice Address - Country:US
Practice Address - Phone:956-753-3901
Practice Address - Fax:956-753-3434
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8549207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179393701Medicaid
TX179393702Medicaid
TX170098104Medicaid
TX8F2195Medicare PIN