=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649498197
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATZUL URRACA VILLALOBOS LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1313 NW 36TH ST STE 400
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33142-5581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-635-7444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10853 SW 68TH DR
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-2002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-274-0113
-----------------------------------------------------
Fax | 305-274-0113
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW000712
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------