Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | F-26401 | TX |
NPI | 1023342151 |
---|---|
Provider Name | Marianela Villarreal |
First Address | San Antonio, TX 78248-2318 |
Second Address | San Antonio, TX 78229-3901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2009 |
Last Update Date | 19/04/2011 |