Healthcare Provider Details

I. General information

NPI: 1649538828
Provider Name (Legal Business Name): OCTAVIO AVILA ZAMORA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: OCTAVIO AVILA ZAMORA M.D

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 SW 152ND ST
MIAMI FL
33177-1111
US

IV. Provider business mailing address

7853 SW 56TH ST APT A 219
MIAMI FL
33155-4389
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-4300
  • Fax: 786-533-9267
Mailing address:
  • Phone: 786-202-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10043361
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME123042
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: