Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 10522 | CO |
N | 1223P0221X | Pediatric Dentist | 29480 | TX |
Y | 1223P0221X | Pediatric Dentist | DN 18711 | FL |
NPI | 1013216605 |
---|---|
Provider Name | Dr. Patricia Villalta |
First Address | Orlando, FL 32819-4064 |
Second Address | Clermont, FL 34711-5199 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2011 |
Last Update Date | 04/05/2015 |