Provider Demographics
NPI:1558706911
Name:MARIE CLAIRE VILLANUEVA, DPM, PA
Entity Type:Organization
Organization Name:MARIE CLAIRE VILLANUEVA, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE-CLAIRE
Authorized Official - Middle Name:D
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:321-213-0249
Mailing Address - Street 1:125 E MERRITT ISLAND CSWY
Mailing Address - Street 2:SUITE 209-310
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3699
Mailing Address - Country:US
Mailing Address - Phone:321-480-7566
Mailing Address - Fax:
Practice Address - Street 1:125 E MERRITT ISLAND CSWY
Practice Address - Street 2:SUITE 209-310
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3699
Practice Address - Country:US
Practice Address - Phone:321-480-7566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 0002657213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty