Individual
ALEXANDRA VILLALBA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
240 MAIN ST, BRISTOL, CT 06010-6337
(860) 585-3469
Mailing address
13732 NW 16TH ST, PEMBROKE PINES, FL 33028-3037
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
09/09/2019
Last updated
09/09/2019
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