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General NPI Number Information
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NPI Number | 1487827242
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Entity Type | Individual
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Provider Name | JULIO CESAR REYES-GAVILAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2008
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | 2240 NW 87TH AVE
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City | DORAL
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State | FL
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Zip | 33172-2414
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Country | US
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Telephone | 786-655-0095
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Fax | 786-870-5651
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Provider Business Mailing Address
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Address Line | 16015 SW 102ND LN
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City | MIAMI
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State | FL
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Zip | 33196-6173
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Country | US
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Telephone | 786-655-0095
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Fax | 786-870-5651
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME121514
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License Number State | FL
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