Provider Demographics
NPI:1851640809
Name:HEVILLA, GERARDO JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:JOSE
Last Name:HEVILLA
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 1:2130 HIBISCUS CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2355
Mailing Address - Country:US
Mailing Address - Phone:305-957-9219
Mailing Address - Fax:
Practice Address - Street 1:2130 HIBISCUS CIR
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2355
Practice Address - Country:US
Practice Address - Phone:305-798-4471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55062208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice