Organization
VILLANUEVA MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAUL VILLANUEVA MD (OWNER)
(954) 271-0135
Entity
Organization
Contact information
Practice address
1451 NE 4TH AVE, FORT LAUDERDALE, FL 33304-1033
(954) 271-0135
(954) 271-0135
Mailing address
1451 NE 4TH AVE, FORT LAUDERDALE, FL 33304-1033
(954) 271-0135
(954) 271-0135
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
ME98244
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME98244
STATE LICENSE
FL
Enumeration date
10/30/2012
Last updated
07/21/2023
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