Provider Demographics
NPI:1649974734
Name:GARCIA VILLALON, PEDRO PABLO
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:PABLO
Last Name:GARCIA VILLALON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 N FLAMINGO RD STE 280
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1031
Mailing Address - Country:US
Mailing Address - Phone:305-982-8810
Mailing Address - Fax:
Practice Address - Street 1:1806 N FLAMINGO RD STE 280
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1031
Practice Address - Country:US
Practice Address - Phone:305-982-8810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11024863363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily