Healthcare Provider Details

I. General information

NPI: 1609636109
Provider Name (Legal Business Name): JULIO CESAR GIL ULLOA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 NW 42ND AVE STE 101
MIAMI FL
33126-4174
US

IV. Provider business mailing address

4353 NW 77TH AVE FL 3
MIAMI FL
33166-6736
US

V. Phone/Fax

Practice location:
  • Phone: 305-946-1526
  • Fax: 877-550-1853
Mailing address:
  • Phone: 305-204-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11031788
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: