Provider Demographics
NPI:1124207154
Name:VILASUSO, JAVIER F (MD)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:F
Last Name:VILASUSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7154 N UNIVERSITY DR # 316
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2916
Mailing Address - Country:US
Mailing Address - Phone:954-720-3188
Mailing Address - Fax:954-586-2589
Practice Address - Street 1:7171 N UNIVERSITY DR STE 300
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2902
Practice Address - Country:US
Practice Address - Phone:954-720-3188
Practice Address - Fax:954-586-2589
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME106794208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine