| Doctor Name: | DR. CARLOS R VILLALTA |
| NPI Number: | 1639137193 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | J3646 |
| Business Practice Address: | 210 S Bryan Rd Suite 5a Mission, TX - 785726204 |
| Business Phone Number: | 9565856611 |
| Business Fax Number: | 9565245157 |
| Mailing Address: | Po Box 1632, MISSION |
| State: | TX |
| Postal Code: | 785730029 |
| Phone Number: | 9563429600 |
| Fax Number: | 9565245157 |
| NPI Enumeration Date: | 05/03/2006 |
| NPI Last Update Date: | 07/26/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | J3646 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |