MEDICARE: JOSE L AVILA MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME77537	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225080039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE L AVILA MD PA

Provider Business Mailing Address
First Line	:	413 TAMARIND DR
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-6541
Country	:	US
Telephone Number	:	305-956-7755
Fax Number	:	305-956-5688

Provider Business Practice Location Address
First Line	:	1380 NE MIAMI GARDENS DR
Second Line	:	SUITE 132
City	:	N MIAMI BEACH
State	:	FL
Zip	:	33179-4707
Country	:	US
Telephone Number	:	305-956-7755
Fax Number	:	305-956-5688

Authorized Official
Title or Position	:	OWNER/PRES
Name	:	DR. JOSE LUIS AVILA
Credential	:	MD
Telephone Number	:	305-956-7755

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	06/24/2008

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Directions to “JOSE L AVILA MD PA ” Practice Location

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