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General NPI Number Information
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NPI Number | 1477673762
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Entity Type | Individual
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Provider Name | WANDA I VILLANUEVA GONZALEZ MD
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Gender | Female
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 1305 N ORANGE AVE
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-2547
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Country | US
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Telephone | 904-284-5904
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Fax | 904-284-5905
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Provider Business Mailing Address
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Address Line | HC 2 BOX 6355
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City | BAJADERO
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State | PR
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Zip | 00616-9760
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Country | US
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Telephone | 407-593-0918
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 14440
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN706
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License Number State | FL
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