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General NPI Number Information
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NPI Number | 1003912817
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Entity Type | Organization
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Legal Business Name | TOMAS VILLANUEVA D.O. P.A.
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 11760 SW 40TH ST STE 112
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City | MIAMI
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State | FL
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Zip | 33175-3589
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Country | US
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Telephone | 305-552-6969
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Fax | 305-485-3533
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Provider Business Mailing Address
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Address Line | 11760 SW 40TH ST SUITE112
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City | MIAMI
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State | FL
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Zip | 33175-3582
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Country | US
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Telephone | 305-552-6969
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Fax | 305-485-3533
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Authorized Official
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Title or Position | DIRECTOROWNER/PHYSICIAN
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Name | DR. TOMAS VILLANUEVA
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Credential | D.O.
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Telephone | 305-552-6969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS0006373
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License Number State | FL
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