Healthcare Provider Details

I. General information

NPI: 1699635466
Provider Name (Legal Business Name): LEGACY SOLUTION VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 NW 84TH AVE STE 108
PLANTATION FL
33324-1847
US

IV. Provider business mailing address

350 NW 84TH AVE STE 108
PLANTATION FL
33324-1847
US

V. Phone/Fax

Practice location:
  • Phone: 800-531-1587
  • Fax:
Mailing address:
  • Phone: 800-531-1587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: EUGENIO J VILLARREAL
Title or Position: AUTH OFF
Credential: MD
Phone: 800-531-1587