Provider Demographics
NPI:1972357887
Name:FERNANDEZ VILLA, SARAINM DE LA ASUNCION
Entity Type:Individual
Prefix:
First Name:SARAINM
Middle Name:DE LA ASUNCION
Last Name:FERNANDEZ VILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 E LAMBRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-1636
Mailing Address - Country:US
Mailing Address - Phone:727-221-8011
Mailing Address - Fax:
Practice Address - Street 1:4150 N ARMENIA AVE STE 102
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6448
Practice Address - Country:US
Practice Address - Phone:813-877-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL96933225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist