Provider Demographics
NPI:1689856528
Name:PALM BEACH CARDIOVASCULAR CLINIC LLC
Entity Type:Organization
Organization Name:PALM BEACH CARDIOVASCULAR CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUSTO
Authorized Official - Middle Name:ERNESTO
Authorized Official - Last Name:VILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-627-2210
Mailing Address - Street 1:600 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2778
Mailing Address - Country:US
Mailing Address - Phone:561-627-2210
Mailing Address - Fax:561-627-2130
Practice Address - Street 1:3385 BURNS RD
Practice Address - Street 2:SUITE 108
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4328
Practice Address - Country:US
Practice Address - Phone:561-627-2210
Practice Address - Fax:561-627-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50208207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21776OtherMEDICARE NUMBER