Provider Demographics
NPI:1467152942
Name:SARABIA, MIGUEL ANTONIO VILLAROSA
Entity Type:Individual
Prefix:
First Name:MIGUEL ANTONIO
Middle Name:VILLAROSA
Last Name:SARABIA
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 1:1768 LEE JANZEN DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-3951
Mailing Address - Country:US
Mailing Address - Phone:443-255-0631
Mailing Address - Fax:
Practice Address - Street 1:1415 SLIGH BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-3954
Practice Address - Country:US
Practice Address - Phone:407-843-5744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR241264390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program