Provider Demographics
NPI:1023033594
Name:VILLAR, DEISE (MD)
Entity Type:Individual
Prefix:MRS
First Name:DEISE
Middle Name:
Last Name:VILLAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 557367
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33255-7367
Mailing Address - Country:US
Mailing Address - Phone:305-669-6505
Mailing Address - Fax:305-669-6447
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:PEDIATRIC CARE CENTER DEPT.
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-669-6505
Practice Address - Fax:305-669-6447
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 59830208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268411000Medicaid