Provider Demographics
NPI:1336258078
Name:VILLAVERDE, RICHARD JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOSE
Last Name:VILLAVERDE
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 1:7600 W 20TH AVE STE 223
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1821
Mailing Address - Country:US
Mailing Address - Phone:305-822-9489
Mailing Address - Fax:305-822-5929
Practice Address - Street 1:7600 W 20TH AVE STE 223
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1821
Practice Address - Country:US
Practice Address - Phone:305-822-9489
Practice Address - Fax:305-822-5929
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME15539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME15539Medicare ID - Type Unspecified