| Villa Family Clinic, Pc | |
|
2000 Se Loop 410 Ste 127a San Antonio TX 78220-4933 | |
| (210) 447-7961 | |
| (210) 442-8973 |
| Full Name | Villa Family Clinic, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 2000 Se Loop 410 Ste 127a, San Antonio, Texas |
| Authorized Official Name and Position | Jose L Villa (CEO) |
| Authorized Official Contact | 2104477961 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Villa Family Clinic, Pc 11727 Fabiana San Antonio TX 78253-5659 Ph: (210) 859-2531 | Villa Family Clinic, Pc 2000 Se Loop 410 Ste 127a San Antonio TX 78220-4933 Ph: (210) 447-7961 |
| NPI Number | 1659930634 |
|---|---|
| Provider Enumeration Date | 06/12/2019 |
| Last Update Date | 06/12/2019 |
| Medicare PECOS PAC ID | 6305174855 |
|---|---|
| Medicare Enrollment ID | O20190830001060 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659930634 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jose Luis Villa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487661781 PECOS PAC ID: 6305871559 Enrollment ID: I20050927001063 |
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