Provider Demographics
NPI:1366840191
Name:J L MORILLO MD PA
Entity Type:Organization
Organization Name:J L MORILLO MD PA
Other - Org Name:EYE SURGERY CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAQUIN
Authorized Official - Middle Name:LEONARDO
Authorized Official - Last Name:MORILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-376-2266
Mailing Address - Street 1:8809 COMMODITY CIR
Mailing Address - Street 2:#2
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9052
Mailing Address - Country:US
Mailing Address - Phone:407-704-7878
Mailing Address - Fax:
Practice Address - Street 1:8809 COMMODITY CIR
Practice Address - Street 2:#2
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9052
Practice Address - Country:US
Practice Address - Phone:407-704-7878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:J L MORILLO MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 45121261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain