Provider Demographics
NPI:1558432997
Name:VILLABONA, CARMEN VANESSA (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:VANESSA
Last Name:VILLABONA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1002
Mailing Address - Country:US
Mailing Address - Phone:305-243-3636
Mailing Address - Fax:305-243-6575
Practice Address - Street 1:1475 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1002
Practice Address - Country:US
Practice Address - Phone:305-243-3636
Practice Address - Fax:305-243-6575
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2024-01-09
Deactivation Date:2019-09-27
Deactivation Code:
Reactivation Date:2019-10-03
Provider Licenses
StateLicense IDTaxonomies
FLME101645207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine