Healthcare Provider Details

I. General information

NPI: 1184596819
Provider Name (Legal Business Name): TAMARA VILLANUEVA LUGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W 47TH PL APT 212B
HIALEAH FL
33012-3202
US

IV. Provider business mailing address

1300 W 47TH PL APT 212B
HIALEAH FL
33012-3202
US

V. Phone/Fax

Practice location:
  • Phone: 786-443-3222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: