Provider Demographics
NPI:1578605614
Name:MENDEZ-VILLAMIL, FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:MENDEZ-VILLAMIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1898 SW 22ND STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2731
Mailing Address - Country:US
Mailing Address - Phone:305-860-8484
Mailing Address - Fax:305-860-2084
Practice Address - Street 1:1898 SW 22ND STREET
Practice Address - Street 2:SUITE B
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2731
Practice Address - Country:US
Practice Address - Phone:305-860-8484
Practice Address - Fax:305-860-2084
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00756852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43377Medicare ID - Type UnspecifiedMEDICARE PROVIDER
FLG83410Medicare UPIN