Healthcare Provider Details

I. General information

NPI: 1902010861
Provider Name (Legal Business Name): NATALIA VILLATE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 S PINE ISLAND RD SUITE A100
PLANTATION FL
33324-3118
US

IV. Provider business mailing address

850 S PINE ISLAND RD SUITE A100
PLANTATION FL
33324-3118
US

V. Phone/Fax

Practice location:
  • Phone: 954-741-5555
  • Fax: 954-572-9658
Mailing address:
  • Phone: 954-741-5555
  • Fax: 954-572-9658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME0102239
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberME0102239
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: