Provider Demographics
NPI:1790424059
Name:VILLA MEDICAL CENTER
Entity Type:Organization
Organization Name:VILLA MEDICAL CENTER
Other - Org Name:VILLA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MINERVA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-FNP-BC
Authorized Official - Phone:786-301-0810
Mailing Address - Street 1:2441 NW 93RD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4800
Mailing Address - Country:US
Mailing Address - Phone:786-391-4464
Mailing Address - Fax:
Practice Address - Street 1:2441 NW 93RD AVE STE 102
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-4800
Practice Address - Country:US
Practice Address - Phone:786-391-4464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-03
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care