Provider Demographics
NPI:1053575050
Name:VILLAFRADEZ-DIAZ, MAGALY (MD)
Entity type:Individual
Prefix:DR
First Name:MAGALY
Middle Name:
Last Name:VILLAFRADEZ-DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LILIAM
Other - Middle Name:MAGALY
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1403 MEDICAL PLAZA DR STE 207
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1047
Mailing Address - Country:US
Mailing Address - Phone:321-364-0728
Mailing Address - Fax:321-364-0729
Practice Address - Street 1:1403 MEDICAL PLAZA DR STE 207
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1047
Practice Address - Country:US
Practice Address - Phone:321-364-0728
Practice Address - Fax:321-364-0729
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125151207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology