Basic Information
| Provider Information | |||||||||
| NPI: | 1962048041 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VILLARREAL | ||||||||
| FirstName: | LISETTE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6605 SALOUMEH WAY | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784132184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3615489142 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5638 SARATOGA BLVD | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784144133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3614445280 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2019 | ||||||||
| LastUpdateDate: | 12/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/16/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP143280 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.