Provider Demographics
NPI:1275646044
Name:QUILICHINI, JOSE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:QUILICHINI
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 1:8340 NW 115TH CT
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1958
Mailing Address - Country:US
Mailing Address - Phone:787-383-6161
Mailing Address - Fax:305-884-7719
Practice Address - Street 1:1629 SANTA EDUVIGIS
Practice Address - Street 2:URB. SAGRADO CORAZON
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-383-6162
Practice Address - Fax:787-434-6214
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8778208600000X
FLME108127208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRFK604AOtherMEDICARE
PRFK604AOtherMEDICARE