Individual
CARLOS VILLANUEVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2200 BERGQUIST DR STE 1, LACKLAND A F B, TX 78236-9908
(210) 292-7956
Mailing address
3835 OTONO, SAN ANTONIO, TX 78223-3998
(915) 204-7641
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
077977
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP116633
TX
390200000X
Student in an Organized Health Care Education/Training Program
643428
TX
Other
Enumeration date
02/05/2007
Last updated
08/04/2017
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