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NPI Code Detail

MEDICARE: VILLANUEVA MEDICAL GROUP LLC

MEDICARE: VILLANUEVA MEDICAL GROUP LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RI0200XInfectious Disease PhysicianME98244FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ME98244OTHERFLSTATE LICENSE

General Provider Information

NPI Number : 1609120666
Entity Type Code : Organization
Provider Name (Legal Business Name) : VILLANUEVA MEDICAL GROUP LLC
Provider Business Mailing Address
First Line : 1451 NE 4TH AVE
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33304-1033
Country : US
Telephone Number : 954-271-0135
Fax Number : 954-271-0135
Provider Business Practice Location Address
First Line : 1451 NE 4TH AVE
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33304-1033
Country : US
Telephone Number : 954-271-0135
Fax Number : 954-271-0135
Authorized Official
Title or Position : OWNER
Name : RAUL VILLANUEVA
Credential : MD
Telephone Number : 954-271-0135
Provider Enumeration Date : 10/30/2012
Last Update Date : 07/21/2023

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Directions to “VILLANUEVA MEDICAL GROUP LLC ” Practice Location

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