Provider Demographics
NPI:1578877973
Name:LILLO, JAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:
Last Name:LILLO
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 1:621 CALLE ACEITILLO
Mailing Address - Street 2:URB. LOS CAOBOS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2602
Mailing Address - Country:US
Mailing Address - Phone:787-396-9001
Mailing Address - Fax:
Practice Address - Street 1:621 CALLE ACEITILLO
Practice Address - Street 2:URB. LOS CAOBOS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2602
Practice Address - Country:US
Practice Address - Phone:787-623-5420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2014-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18804208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice