Healthcare Provider Details

I. General information

NPI: 1144678871
Provider Name (Legal Business Name): ANA VILA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8849 NW 119 ST UNIT 207
HIALEAH FL
33018
US

IV. Provider business mailing address

8849 NW 119 ST UNIT 207
HIALEAH FL
33018
US

V. Phone/Fax

Practice location:
  • Phone: 786-356-7525
  • Fax:
Mailing address:
  • Phone: 786-356-7525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number1505626
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: