Provider Demographics
NPI:1437840394
Name:VILLABELLA LLEVARA, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:VILLABELLA LLEVARA
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 1:1430 SW 103RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2767
Mailing Address - Country:US
Mailing Address - Phone:786-564-9077
Mailing Address - Fax:
Practice Address - Street 1:4471 NW 36TH ST STE 2002
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-7290
Practice Address - Country:US
Practice Address - Phone:786-471-1844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-269006106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty