Healthcare Provider Details

I. General information

NPI: 1821415027
Provider Name (Legal Business Name): PAOLA A CINTRON VILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21110 BISCAYNE BLVD STE 203
MIAMI FL
33180-1251
US

IV. Provider business mailing address

PO BOX 69
JUPITER FL
33468
US

V. Phone/Fax

Practice location:
  • Phone: 305-948-9595
  • Fax: 305-948-9292
Mailing address:
  • Phone: 561-932-0995
  • Fax: 561-406-6067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME128059
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: