Provider Demographics
NPI:1871573048
Name:VILLAREAL, ROLANDO LOYOLA (MD)
Entity type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:LOYOLA
Last Name:VILLAREAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17250 N 43RD AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4035
Mailing Address - Country:US
Mailing Address - Phone:602-978-4157
Mailing Address - Fax:602-938-8064
Practice Address - Street 1:17250 N 43RD AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-4035
Practice Address - Country:US
Practice Address - Phone:602-978-4157
Practice Address - Fax:602-938-8064
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6828208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery