Provider Demographics
NPI:1366460974
Name:VILLA, AUGUSTO ERNESTO (MD)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTO
Middle Name:ERNESTO
Last Name:VILLA
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 1:600 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE-200
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458
Mailing Address - Country:US
Mailing Address - Phone:561-627-2210
Mailing Address - Fax:561-627-5850
Practice Address - Street 1:600 UNIVERSITY BLVD
Practice Address - Street 2:SUITE-200
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-627-2210
Practice Address - Fax:561-627-5850
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50208207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D51104Medicare UPIN
FL04775ZMedicare PIN