Healthcare Provider Details

I. General information

NPI: 1316057763
Provider Name (Legal Business Name): LETTY M. VILLA MD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6705 SW 57 AVE., SUITE # 420
CORAL GABLES FL
33143
US

IV. Provider business mailing address

6705 SW 57 AVE., SUITE # 420
CORAL GABLES FL
33143
US

V. Phone/Fax

Practice location:
  • Phone: 305-667-8418
  • Fax: 305-667-3365
Mailing address:
  • Phone: 305-667-8418
  • Fax: 305-667-3365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberME43761
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: