Provider Demographics
NPI:1326173881
Name:VILLOCH ASSOCIATES MD, PA.
Entity Type:Organization
Organization Name:VILLOCH ASSOCIATES MD, PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:R
Authorized Official - Last Name:VILLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:305-856-6081
Mailing Address - Street 1:5005 ORDUNA DR
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2036
Mailing Address - Country:US
Mailing Address - Phone:305-662-2592
Mailing Address - Fax:
Practice Address - Street 1:2075 SW 27TH AVE FL 1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2540
Practice Address - Country:US
Practice Address - Phone:305-856-6081
Practice Address - Fax:305-854-5968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59094173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11709OtherBCBS
FL11709OtherBCBS
FL11709ZMedicare ID - Type UnspecifiedINDIVIDUAL
FLE69721Medicare UPIN