Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 0S 7470 | FL |
NPI | 1003804287 |
---|---|
Provider Name | Mary Jo Villar |
First Address | Hialeah, FL 33016-1821 |
Second Address | Hialeah, FL 33016-1821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 27/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
258647900 | (05) | FL |
H24474 | (02) | FL |