Healthcare Provider Details

I. General information

NPI: 1124207154
Provider Name (Legal Business Name): JAVIER F VILASUSO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8740 N KENDALL DR STE 208
MIAMI FL
33176-2221
US

IV. Provider business mailing address

PO BOX 223190
HOLLYWOOD FL
33022-3190
US

V. Phone/Fax

Practice location:
  • Phone: 305-974-5533
  • Fax: 305-974-5553
Mailing address:
  • Phone: 59-745-5533
  • Fax: 59-745-5533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME106794
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: