Provider Demographics
NPI:1285037234
Name:VILA, SINUHE
Entity Type:Individual
Prefix:
First Name:SINUHE
Middle Name:
Last Name:VILA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 TAM O SHANTER DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-1906
Mailing Address - Country:US
Mailing Address - Phone:561-667-1418
Mailing Address - Fax:561-200-5595
Practice Address - Street 1:237 TAM O SHANTER DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-1906
Practice Address - Country:US
Practice Address - Phone:561-667-2080
Practice Address - Fax:561-286-3970
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
CO1-17-27722103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018274400Medicaid