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General NPI Number Information
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NPI Number | 1225080039
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Entity Type | Organization
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Legal Business Name | JOSE L AVILA MD PA
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 1380 NE MIAMI GARDENS DR SUITE 132
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City | N MIAMI BEACH
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State | FL
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Zip | 33179-4707
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Country | US
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Telephone | 305-956-7755
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Fax | 305-956-5688
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Provider Business Mailing Address
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Address Line | 413 TAMARIND DR
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-6541
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Country | US
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Telephone | 305-956-7755
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Fax | 305-956-5688
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Authorized Official
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Title or Position | OWNER/PRES
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Name | DR. JOSE LUIS AVILA
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Credential | MD
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Telephone | 305-956-7755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME77537
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License Number State | FL
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