Provider Demographics
NPI:1134124365
Name:VILLACIAN, FERNANDO (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:VILLACIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 SW 97TH AVE
Mailing Address - Street 2:SUITE #208
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1494
Mailing Address - Country:US
Mailing Address - Phone:305-227-7780
Mailing Address - Fax:305-227-7780
Practice Address - Street 1:7000 SW 97TH AVE
Practice Address - Street 2:SUITE #208
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1494
Practice Address - Country:US
Practice Address - Phone:305-227-7780
Practice Address - Fax:305-227-7780
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME35668174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038526300Medicaid
FL038526300Medicaid
FLD63422Medicare UPIN