Healthcare Provider Details

I. General information

NPI: 1326173881
Provider Name (Legal Business Name): VILLOCH ASSOCIATES MD, PA.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 SW 27TH AVE FL 1
MIAMI FL
33145-2540
US

IV. Provider business mailing address

5005 ORDUNA DR
CORAL GABLES FL
33146-2036
US

V. Phone/Fax

Practice location:
  • Phone: 305-856-6081
  • Fax: 305-854-5968
Mailing address:
  • Phone: 305-662-2592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME59094
License Number StateFL

VIII. Authorized Official

Name: DR. MARIO R VILLOCH
Title or Position: PRESIDENT
Credential: M.D.,
Phone: 305-856-6081