Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | S4411 | TX |
N | 207RA0201X | Internist - Allergy & Immunology | S4411 | TX |
NPI | 1083008908 |
---|---|
Provider Name | Raul Sergio Villarreal JR. |
First Address | San Antonio, TX 78229-4870 |
Second Address | San Antonio, TX 78229-4870 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2015 |
Last Update Date | 14/08/2020 |