Healthcare Provider Details

I. General information

NPI: 1194827097
Provider Name (Legal Business Name): ALEX TAN VILLACASTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10489 N FLORIDA AVE
CITRUS SPRINGS FL
34434-3268
US

IV. Provider business mailing address

10489 N FLORIDA AVE
CITRUS SPRINGS FL
34434-3268
US

V. Phone/Fax

Practice location:
  • Phone: 352-489-2486
  • Fax: 352-489-5786
Mailing address:
  • Phone: 352-489-2486
  • Fax: 352-489-5786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME071085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: