Provider Demographics
NPI:1083622427
Name:VILORIA, JESUS (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:
Last Name:VILORIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2678 NW 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1400
Mailing Address - Country:US
Mailing Address - Phone:305-640-1786
Mailing Address - Fax:305-640-1788
Practice Address - Street 1:2678 NW 97TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1400
Practice Address - Country:US
Practice Address - Phone:305-640-1786
Practice Address - Fax:305-640-1788
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61793207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104016600Medicaid
FLME0061793OtherFLORIDA LICENSE NUMBER