Healthcare Provider Details

I. General information

NPI: 1467114355
Provider Name (Legal Business Name): THOMAS L VILLARAZA SLPA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 SW 1ST ST
MIAMI FL
33135-2202
US

IV. Provider business mailing address

1441 SW 1ST ST
MIAMI FL
33135-2202
US

V. Phone/Fax

Practice location:
  • Phone: 786-431-1877
  • Fax: 305-541-4949
Mailing address:
  • Phone: 786-431-1877
  • Fax: 305-541-4949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSI4735
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: