MEDICARE: DR. WANDA I VILLANUEVA GONZALEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	14440	PR
2	208D00000X	General Practice Physician	ACN706	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IH341Z	OTHER	FL	FLORIFA MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477673762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WANDA I VILLANUEVA GONZALEZ MD

Provider Business Mailing Address
First Line	:	HC 2 BOX 6355
Second Line	:
City	:	BAJADERO
State	:	PR
Zip	:	00616-9760
Country	:	US
Telephone Number	:	407-593-0918
Fax Number	:

Provider Business Practice Location Address
First Line	:	1305 N ORANGE AVE
Second Line	:
City	:	GREEN COVE SPRINGS
State	:	FL
Zip	:	32043-2547
Country	:	US
Telephone Number	:	904-284-5904
Fax Number	:	904-284-5905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	09/04/2025

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