Provider Demographics
NPI:1265654263
Name:VILLANUEVA, RAUL (MD)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAUL
Other - Middle Name:
Other - Last Name:VILLANUEVA CALDERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1451 NE 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1033
Mailing Address - Country:US
Mailing Address - Phone:954-271-0135
Mailing Address - Fax:954-271-0135
Practice Address - Street 1:1451 NE 4TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1033
Practice Address - Country:US
Practice Address - Phone:954-271-0135
Practice Address - Fax:954-271-0135
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98244207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278084400Medicaid
FLAD998ZMedicare PIN