MEDICARE: NOEL RODRIGUEZ-VILLANUEVA MD

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
1	208D00000X	General Practice Physician	14882	PR
2	208D00000X	General Practice Physician	ACN1089	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790768059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOEL RODRIGUEZ-VILLANUEVA MD

Provider Business Mailing Address
First Line	:	1724 E HALLANDALE BEACH BLVD STE 2A
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4611
Country	:	US
Telephone Number	:	954-456-9696
Fax Number	:

Provider Business Practice Location Address
First Line	:	1724 E HALLANDALE BEACH BLVD STE 2A
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4611
Country	:	US
Telephone Number	:	954-456-9696
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	07/11/2022

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Directions to “ NOEL RODRIGUEZ-VILLANUEVA MD” Practice Location

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