Provider Demographics
NPI:1215235650
Name:VILA, SULEMA
Entity type:Individual
Prefix:
First Name:SULEMA
Middle Name:
Last Name:VILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4809 SW 41ST ST
Mailing Address - Street 2:APT 101
Mailing Address - City:PEMBROKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023-6996
Mailing Address - Country:US
Mailing Address - Phone:954-274-7877
Mailing Address - Fax:
Practice Address - Street 1:12401 ORANGE DR
Practice Address - Street 2:SUITE 219
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4341
Practice Address - Country:US
Practice Address - Phone:954-862-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002169800Medicaid