Healthcare Provider Details

I. General information

NPI: 1710021266
Provider Name (Legal Business Name): OMAR ALEJANDRO SANCHEZ VILLANUEVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CENTER ST PICU
MOBILE AL
36604-3301
US

IV. Provider business mailing address

PO BOX 40480
MOBILE AL
36640-0480
US

V. Phone/Fax

Practice location:
  • Phone: 251-415-1546
  • Fax: 251-415-1026
Mailing address:
  • Phone: 251-415-1546
  • Fax: 251-415-1026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME 113837
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 113837
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number32466
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: