Provider Demographics
NPI:1588433577
Name:VILLARREAL, MARIA ELENA (LDO)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4965 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32571-1408
Mailing Address - Country:US
Mailing Address - Phone:850-995-1428
Mailing Address - Fax:850-995-8638
Practice Address - Street 1:4965 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32571-1408
Practice Address - Country:US
Practice Address - Phone:850-995-1428
Practice Address - Fax:850-995-8638
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7267156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician