Basic Information
| Provider Information | |||||||||
| NPI: | 1336308485 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VILLANUEVA | ||||||||
| FirstName: | CAROLINA | ||||||||
| MiddleName: | PAULA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 5TH STREET | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331396508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863996028 | ||||||||
| FaxNumber: | 3055321164 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 CRANDON BLVD | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | KEY BISCAYNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053616232 | ||||||||
| FaxNumber: | 3053650031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2008 | ||||||||
| LastUpdateDate: | 10/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | ME96337 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | 208000000X | ME96337 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 003341500 | 05 | FL | MEDICAID |