Healthcare Provider Details

I. General information

NPI: 1881662435
Provider Name (Legal Business Name): FABIO E. VILLEGAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 12/27/2020
Certification Date: 12/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 OAK SHORE DR
SAINT CLOUD FL
34771-8748
US

IV. Provider business mailing address

6101 OAK SHORE DR
SAINT CLOUD FL
34771-8748
US

V. Phone/Fax

Practice location:
  • Phone: 407-350-9499
  • Fax:
Mailing address:
  • Phone: 407-350-9499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME94636
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME 94636
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number94636
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: