Provider Demographics
NPI:1952476541
Name:VILLEGAS, REMIGIO C JR (MD)
Entity Type:Individual
Prefix:
First Name:REMIGIO
Middle Name:C
Last Name:VILLEGAS
Suffix:JR
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 1:400 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3122
Mailing Address - Country:US
Mailing Address - Phone:321-722-5273
Mailing Address - Fax:
Practice Address - Street 1:6700 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-8050
Practice Address - Country:US
Practice Address - Phone:321-722-5200
Practice Address - Fax:321-953-7510
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME691892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253046500Medicaid
FL31243ZMedicare ID - Type Unspecified
FLG26928Medicare UPIN