Healthcare Provider Details

I. General information

NPI: 1851459606
Provider Name (Legal Business Name): PEDRO RAUL VILLANUEVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 N ROBERT AVE
ARCADIA FL
34266-9580
US

IV. Provider business mailing address

700 8TH AVE W STE 101
PALMETTO FL
34221-4737
US

V. Phone/Fax

Practice location:
  • Phone: 863-494-8410
  • Fax: 863-491-5306
Mailing address:
  • Phone: 941-776-4008
  • Fax: 941-845-4963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME50602
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: