Provider Demographics
NPI:1356304885
Name:EGUSQUIZA, JULIO CESAR (MD)
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:CESAR
Last Name:EGUSQUIZA
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 1:3220 SW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3606
Mailing Address - Country:US
Mailing Address - Phone:305-551-1195
Mailing Address - Fax:305-551-1094
Practice Address - Street 1:7100 W 20TH AVE
Practice Address - Street 2:SUITE 411
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1897
Practice Address - Country:US
Practice Address - Phone:305-823-0901
Practice Address - Fax:305-558-5304
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54356208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259572901Medicaid
FL259572900Medicaid
FL259572900Medicaid