Healthcare Provider Details

I. General information

NPI: 1124392550
Provider Name (Legal Business Name): MARIA E VILLARREAL R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14155 SW 87TH ST E 207
MIAMI FL
33183-4091
US

IV. Provider business mailing address

14155 SW 87TH ST E 207
MIAMI FL
33183-4091
US

V. Phone/Fax

Practice location:
  • Phone: 305-588-2745
  • Fax:
Mailing address:
  • Phone: 305-588-2745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH11708
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: