| Organization Name: | CORAL J VILLANUEVA DPM PA |
| NPI Number: | 1437336690 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CORAL J VILLANUEVA (PRESIDENT) |
| Mailing Address: | 1090 Kane Concourse Suite 204 Bay Harbor Islands |
| State: | FL US |
| Postal Code: | 331542130 |
| Phone Number: | 3058939366 |
| Fax Number: | 3058934408 |
| NPI Enumeration Date: | 01/29/2008 |
| NPI Last Update Date: | 11/04/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP1100X |
| License Number: | PO3285 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Podiatric |
| Taxonomy Definition: | |