Provider Demographics
NPI:1427606094
Name:DAVILUS, JOSE
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:DAVILUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 N PINE ISLAND RD APT 213
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1350
Mailing Address - Country:US
Mailing Address - Phone:217-819-1498
Mailing Address - Fax:
Practice Address - Street 1:300 S PINE ISLAND RD STE 246
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2631
Practice Address - Country:US
Practice Address - Phone:217-819-1498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant