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General NPI Number Information
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NPI Number | 1790424059
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Entity Type | Organization
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Legal Business Name | VILLA MEDICAL CENTER
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Dates
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Enumeration Date | 06/03/2022
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | 2441 NW 93RD AVE STE 102
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City | DORAL
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State | FL
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Zip | 33172-4800
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Country | US
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Telephone | 786-391-4464
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Fax |
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Provider Business Mailing Address
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Address Line | 2441 NW 93RD AVE STE 102
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City | DORAL
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State | FL
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Zip | 33172-4800
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Country | US
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Telephone | 786-391-4464
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MINERVA PEREZ
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Credential | APRN-FNP-BC
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Telephone | 786-301-0810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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