Provider Demographics
NPI:1780632612
Name:CHILITO, ALICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:CHILITO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10220 SW 121ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-4839
Mailing Address - Country:US
Mailing Address - Phone:305-269-1988
Mailing Address - Fax:305-503-7566
Practice Address - Street 1:13501 SW 128TH ST STE 207
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5863
Practice Address - Country:US
Practice Address - Phone:305-269-1988
Practice Address - Fax:206-203-1702
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074131207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252652200Medicaid
FL252652200Medicaid
FLK6303BMedicare PIN