Basic Information
| Provider Information | |||||||||
| NPI: | 1821417999 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VILLYARD | ||||||||
| FirstName: | RAFAEL | ||||||||
| MiddleName: | RICARDO | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | SURGICAL ASSISTANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8230 WALNUT HILL LN | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2144903664 | ||||||||
| FaxNumber: | 2149871845 | ||||||||
| Practice Location | |||||||||
| Address1: | 8230 WALNUT HILL LN | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752314482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146911902 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2014 | ||||||||
| LastUpdateDate: | 08/27/2019 | ||||||||
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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 | 246ZC0007X | N | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant | 363AS0400X | SA00766 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.