Provider Demographics
NPI:1013941590
Name:VILLALBA, CARLOS ARTURO (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ARTURO
Last Name:VILLALBA
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 1:4308 ALTON RD
Mailing Address - Street 2:860
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4556
Mailing Address - Country:US
Mailing Address - Phone:305-604-2888
Mailing Address - Fax:305-604-2887
Practice Address - Street 1:4308 ALTON RD
Practice Address - Street 2:860
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4556
Practice Address - Country:US
Practice Address - Phone:305-604-2888
Practice Address - Fax:305-604-2887
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10007829207R00000X
FL109882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEI50866Medicare UPIN
DE019172H67Medicare ID - Type Unspecified