Healthcare Provider Details

I. General information

NPI: 1114030673
Provider Name (Legal Business Name): JULIO C. VIJIL JR. MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N 35TH AVE, SUITE 465
HOLLYWOOD FL
33021-5467
US

IV. Provider business mailing address

1150 N 35TH AVE, SUITE 465
HOLLYWOOD FL
33021-5467
US

V. Phone/Fax

Practice location:
  • Phone: 954-986-9008
  • Fax: 954-986-6646
Mailing address:
  • Phone: 954-986-9008
  • Fax: 954-986-6646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036109508
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME87467
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: