1215981188 NPI number — DR. CELINA Y VILLARREAL O.D.

Table of content: DR. CELINA Y VILLARREAL O.D. (NPI 1215981188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215981188 NPI number — DR. CELINA Y VILLARREAL O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILLARREAL
Provider First Name:
CELINA
Provider Middle Name:
Y
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VILLANUEVA
Provider Other First Name:
CELINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215981188
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2601 VETERANS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLINGEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78550-8942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-291-9000
Provider Business Mailing Address Fax Number:
956-291-9892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 S ZARZAMORA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78207-5209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-358-7600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  06422TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 174326202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 174326207 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 174326208 . This is a "CSHCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".