Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | L8548 | TX |
Y | 207KA0200X | Allergist | L8548 | TX |
NPI | 1437115888 |
---|---|
Provider Name | John F. Villacis |
First Address | Austin, TX 78758-2401 |
Second Address | Austin, TX 78758-2401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 09/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
165659701 | (05) | TX |
P00157014 | RRMCR (01) | TX |