Provider Demographics
NPI:1730380197
Name:ANGULO VILLANUEVA, VIVIAN D (MD)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:D
Last Name:ANGULO VILLANUEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIVIAN
Other - Middle Name:D
Other - Last Name:ANGULO VILLANUEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:425 W COLONIAL DR STE 303
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6863
Mailing Address - Country:US
Mailing Address - Phone:321-332-6947
Mailing Address - Fax:407-286-4515
Practice Address - Street 1:9740 N 56TH ST STE B
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-5500
Practice Address - Country:US
Practice Address - Phone:813-200-7717
Practice Address - Fax:813-985-8500
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13973174400000X
FLME138724207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020911Medicare ID - Type Unspecified