Healthcare Provider Details

I. General information

NPI: 1669366357
Provider Name (Legal Business Name): DANIEL ALEJANDRO VILLASMIL FUENMAYOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 SW 75TH AVE
MIAMI FL
33155-2805
US

IV. Provider business mailing address

2500 SW 75TH AVE
MIAMI FL
33155-2805
US

V. Phone/Fax

Practice location:
  • Phone: 305-264-5252
  • Fax: 305-463-1399
Mailing address:
  • Phone: 305-264-5252
  • Fax: 305-463-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42008
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: