Provider Demographics
NPI:1871792705
Name:VILLAVICENCIO, LOURDES (MS)
Entity type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:
Last Name:VILLAVICENCIO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 SUNSET DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3012
Mailing Address - Country:US
Mailing Address - Phone:305-598-5589
Mailing Address - Fax:
Practice Address - Street 1:10300 SUNSET DR
Practice Address - Street 2:SUITE 280
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3012
Practice Address - Country:US
Practice Address - Phone:305-598-5589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist