Provider Demographics
NPI:1508890849
Name:VILDOSOLA, JOSE IGNACIO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:IGNACIO
Last Name:VILDOSOLA
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:PO BOX 166113
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33116-6113
Mailing Address - Country:US
Mailing Address - Phone:305-383-0045
Mailing Address - Fax:305-383-0045
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:AMBULATORY CARE CENTER
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-8818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66439208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME66439OtherMEDICAL LICENSE
FLBV3810151OtherDEA NUMBER
FLME66439OtherMEDICAL LICENSE
FLF87726Medicare UPIN