Basic Information
| Provider Information | |||||||||
| NPI: | 1215016480 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VILLASENOR | ||||||||
| FirstName: | HECTOR | ||||||||
| MiddleName: | RAUL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 E QUINCY ST STE 427 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782152033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102237500 | ||||||||
| FaxNumber: | 2102239075 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 E QUINCY ST STE 427 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782152033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102237500 | ||||||||
| FaxNumber: | 2102239075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2006 | ||||||||
| LastUpdateDate: | 08/19/2014 | ||||||||
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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 | 207RC0000X | F3371 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 152401901 | 05 | TX | MEDICAID | 137198106 | 05 | TX | MEDICAID | 88T011 | 01 | TX | BCBS | OTHER |