Provider Demographics
NPI:1700590643
Name:VILLATORO, SERGIO ALEJANDRO SR (CBHCMS)
Entity type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:ALEJANDRO
Last Name:VILLATORO
Suffix:SR
Gender:M
Credentials:CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1666 79TH STREET CSWY STE 603
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4190
Mailing Address - Country:US
Mailing Address - Phone:786-518-8931
Mailing Address - Fax:
Practice Address - Street 1:1666 79TH STREET CSWY STE 603
Practice Address - Street 2:
Practice Address - City:NORTH BAY VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:33141-4190
Practice Address - Country:US
Practice Address - Phone:786-518-8931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS.0102575171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator