Individual
JUSTO H VILLANUEVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4201 PALM AVE, SUITE C, HIALEAH, FL 33012-4424
(305) 823-0210
(305) 823-0096
Mailing address
4201 PALM AVE, SUITE C, HIALEAH, FL 33012-4424
(305) 823-0210
(305) 823-0096
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
ME71662
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME71662
FLORIDA LICENSE
FL
Enumeration date
07/25/2008
Last updated
09/21/2012
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