Provider Demographics
NPI:1790534261
Name:VILLA, OSCAR FABIAN (PA-C)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:FABIAN
Last Name:VILLA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 ALTON RD STE 2071
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2948
Mailing Address - Country:US
Mailing Address - Phone:305-674-2071
Mailing Address - Fax:305-535-7983
Practice Address - Street 1:4300 ALTON RD STE 2071
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2948
Practice Address - Country:US
Practice Address - Phone:305-674-2071
Practice Address - Fax:305-535-7983
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9118700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant