Individual
JACOB LEE VILLARREAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2139 ROBERT DEDMAN DR, AUSTIN, TX 78712-1506
(512) 471-7887
Mailing address
PO BOX 444, GONZALES, TX 78629-0444
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/14/2017
Last updated
08/14/2017
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