Basic Information
| Provider Information | |||||||||
| NPI: | 1699927731 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VILLARREAL | ||||||||
| FirstName: | ARTEMIO | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2715 W TRENTON RD | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785393433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566831155 | ||||||||
| FaxNumber: | 9563161717 | ||||||||
| Practice Location | |||||||||
| Address1: | 2715 W TRENTON RD | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785393433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566831155 | ||||||||
| FaxNumber: | 9563161717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2008 | ||||||||
| LastUpdateDate: | 10/21/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 209790 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
ID Information
| ID | Type | State | Issuer | Description | 173943501 | 05 | TX | MEDICAID | 149229001 | 05 | TX | MEDICAID |