Provider Demographics
NPI:1316508443
Name:VILLAS, CARMEN
Entity type:Individual
Prefix:PROF
First Name:CARMEN
Middle Name:
Last Name:VILLAS
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 1:269 MARACA ST
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-5543
Mailing Address - Country:US
Mailing Address - Phone:800-399-2098
Mailing Address - Fax:941-883-6302
Practice Address - Street 1:269 MARACA ST
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983-5543
Practice Address - Country:US
Practice Address - Phone:800-399-2098
Practice Address - Fax:941-883-6302
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies