Healthcare Provider Details

I. General information

NPI: 1336308485
Provider Name (Legal Business Name): CAROLINA PAULA VILLANUEVA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 CRANDON BLVD SUITE 212
KEY BISCAYNE FL
33149
US

IV. Provider business mailing address

1000 5TH STREET SUITE 200
MIAMI BEACH FL
33139-6508
US

V. Phone/Fax

Practice location:
  • Phone: 305-361-6232
  • Fax: 305-365-0031
Mailing address:
  • Phone: 786-399-6028
  • Fax: 305-532-1164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME96337
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME96337
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: