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General NPI Number Information
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NPI Number | 1558706911
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Entity Type | Organization
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Legal Business Name | MARIE CLAIRE VILLANUEVA, DPM, PA
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Dates
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Enumeration Date | 04/30/2013
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Last Update Date | 04/30/2013
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Provider Practice Location Address
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Address Line | 125 E MERRITT ISLAND CSWY SUITE 209-310
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-3699
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Country | US
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Telephone | 321-480-7566
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Fax |
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Provider Business Mailing Address
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Address Line | 125 E MERRITT ISLAND CSWY SUITE 209-310
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-3699
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Country | US
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Telephone | 321-480-7566
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIE-CLAIRE D VILLANUEVA
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Credential | D.P.M.
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Telephone | 321-213-0249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO 0002657
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License Number State | FL
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