=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275940124
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATALIA VILLATE, M.D. P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2014
-----------------------------------------------------
Last Update Date | 07/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9980 CENTRAL PARK BLVD N SUITE 204
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33428-1762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-788-0947
-----------------------------------------------------
Fax | 561-479-1680
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4001 N OCEAN BLVD APT B 704
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33431-5363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-245-8931
-----------------------------------------------------
Fax | 561-479-1680
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | NATALIA VILLATE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 305-788-0947
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | ME102239
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------