Provider Demographics
NPI:1669565453
Name:VILLANUEVA, TOMAS (DO)
Entity type:Individual
Prefix:
First Name:TOMAS
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 N KENDALL DR
Mailing Address - Street 2:SOUTH TOWER 2ND FLOOR
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2118
Mailing Address - Country:US
Mailing Address - Phone:786-596-7774
Mailing Address - Fax:786-596-7998
Practice Address - Street 1:8900 N KENDALL DR
Practice Address - Street 2:SOUTH TOWER 2ND FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2118
Practice Address - Country:US
Practice Address - Phone:786-596-7774
Practice Address - Fax:786-596-7998
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0006373207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80988OtherBCBS
FLF99639Medicare UPIN
FL80988OtherBCBS