MEDICARE: DR. FABIO E. VILLEGAS M.D.

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	208000000X	Pediatrics Physician	ME94636	FL
2	2080A0000X	Pediatric Adolescent Medicine Physician	ME 94636	FL
3	208D00000X	General Practice Physician	94636	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1881662435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FABIO E. VILLEGAS M.D.

Provider Business Mailing Address
First Line	:	6101 OAK SHORE DR
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34771-8748
Country	:	US
Telephone Number	:	407-350-9499
Fax Number	:

Provider Business Practice Location Address
First Line	:	6101 OAK SHORE DR
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34771-8748
Country	:	US
Telephone Number	:	407-350-9499
Fax Number	:

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	12/27/2020

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