Healthcare Provider Details

I. General information

NPI: 1174548218
Provider Name (Legal Business Name): HENRY VILLARREAL ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

9249 DICKENS AVE
SURFSIDE FL
33154-3031
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-5513
  • Fax:
Mailing address:
  • Phone: 305-585-5513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1527972
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: