Healthcare Provider Details

I. General information

NPI: 1275587123
Provider Name (Legal Business Name): JOSE LUIS AVILA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 NE MIAMI GARDENS DR SUITE 132
N MIAMI BEACH FL
33179-4707
US

IV. Provider business mailing address

1380 NE MIAMI GARDENS DR STE 132
N MIAMI BEACH FL
33179-4744
US

V. Phone/Fax

Practice location:
  • Phone: 305-956-7755
  • Fax: 305-956-5688
Mailing address:
  • Phone: 305-956-7755
  • Fax: 305-956-5688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME77537
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: