Provider Demographics
NPI:1114030673
Name:VIJIL, JULIO C JR (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:C
Last Name:VIJIL
Suffix:JR
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 N 35TH AVE, SUITE 465
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5467
Mailing Address - Country:US
Mailing Address - Phone:954-986-9008
Mailing Address - Fax:954-986-6646
Practice Address - Street 1:1150 N 35TH AVE, SUITE 465
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5467
Practice Address - Country:US
Practice Address - Phone:954-986-9008
Practice Address - Fax:954-986-6646
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109508207RN0300X
FLME87467207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001064100Medicaid
FL1114030673Medicaid
K19502Medicare ID - Type Unspecified
FL001064100Medicaid