Healthcare Provider Details

I. General information

NPI: 1033483557
Provider Name (Legal Business Name): CAROLINA VILLANUEVA, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 786-399-6028
  • Fax:
Mailing address:
  • Phone: 786-399-6028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME96337
License Number StateFL

VIII. Authorized Official

Name: CAROLINA VILLANUEVA
Title or Position: MD / OWNER
Credential: MD
Phone: 786-399-6028