Provider Demographics
NPI:1386472264
Name:VILLANUEVA, INGRID (MD)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:
Other - Last Name:VILLANUEVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:INGRID VILLANUEVA
Mailing Address - Street 1:5724 BYRON ANTHONY PLCAE
Mailing Address - Street 2:APARTMENT 312
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-8635
Mailing Address - Country:US
Mailing Address - Phone:787-420-3685
Mailing Address - Fax:
Practice Address - Street 1:5724 BYRON ANTHONY PLCAE
Practice Address - Street 2:APARTMENT 312
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-8635
Practice Address - Country:US
Practice Address - Phone:787-420-3685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL38933207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology