Provider Demographics
NPI:1134645112
Name:VILLEGAS, LINA
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6475 SW 129TH PL APT 409
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5222
Mailing Address - Country:US
Mailing Address - Phone:786-261-4326
Mailing Address - Fax:
Practice Address - Street 1:6475 SW 129TH PL APT 409
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5222
Practice Address - Country:US
Practice Address - Phone:786-261-4326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst