Active NPI
Amalou Villanueva Lim, D.D.S.
- General Practice Dentistry
- Cocoa, FL
National Provider Identifier
1508869876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- HAD128
- Practice address
- 7227 N US Highway 1
Cocoa, FL 32927-5020 - Phone
- (321) 241-6800
- Fax
- (321) 241-6890
- NPI assigned
- May 31, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019022168 | IL | |
| General Practice Dentistry | 1223G0001X | HAD128 | FL | Primary |
Addresses
Primary practice location
7227 N US Highway 1
Cocoa, FL 32927-5020
Mailing address
PO Box 1137
Melbourne, FL 32902-1137
Phone (321) 241-6800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019022168 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brevard Health Alliance Inc | Current | Accepting new patients | |
| Brevard Health Alliance Inc | Current | Accepting new patients | |
| Brevard Health Alliance, Inc. | Current | Accepting new patients | |
| Palatine Dentistry PC | Past | Accepting new patients |
Locations
2120 Sarno Rd
Melbourne, FL 32935
Phone (321) 952-9696
7227 N US Highway 1
Port St John, FL 32927
Phone (321) 631-3693
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Melbourne, FL
- NPI 1013355726
-
- Dentist
- Palatine, IL
- NPI 1295905131
-
- Federally Qualified Health Center (FQHC)
- Cocoa, FL
- NPI 1962857417
-
- Community/Retail Pharmacy
- Melbourne, FL
- NPI 1508735150
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705622400000",
"number": "1508869876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1137",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329021137",
"telephone_number": "321-241-6800",
"fax_number": "321-241-6890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7227 N US HIGHWAY 1",
"city": "COCOA",
"state": "FL",
"postal_code": "329275020",
"telephone_number": "321-241-6800",
"fax_number": "321-241-6890"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIM",
"first_name": "AMALOU",
"middle_name": "VILLANUEVA",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-05-31",
"last_updated": "2024-01-19",
"certification_date": "2024-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019022168",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "HAD128",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Cocoa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.