Provider Demographics
NPI:1790534261
Name:VILLA, OSCAR FABIAN (PA-C)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:FABIAN
Last Name:VILLA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 ALTON RD STE A&B
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3811
Mailing Address - Country:US
Mailing Address - Phone:305-344-2273
Mailing Address - Fax:844-240-8266
Practice Address - Street 1:1329 ALTON RD STE A&B
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-3811
Practice Address - Country:US
Practice Address - Phone:305-344-2273
Practice Address - Fax:844-240-8266
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9118700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant