Provider Demographics
NPI:1417921321
Name:VILLAR CORDOVA, CARLOS EUGENIO (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:EUGENIO
Last Name:VILLAR CORDOVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:E VILLAR
Other - Last Name:CORDOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2210 ASHLEY OAKS CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6404
Mailing Address - Country:US
Mailing Address - Phone:813-618-5867
Mailing Address - Fax:813-433-2545
Practice Address - Street 1:2210 ASHLEY OAKS CIR STE 101
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6404
Practice Address - Country:US
Practice Address - Phone:813-618-5867
Practice Address - Fax:813-433-2545
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010563472084N0400X
FLME788152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257368700Medicaid
FL0471260001Medicare NSC
FL49128ZMedicare PIN