Provider Demographics
NPI:1649538828
Name:AVILA ZAMORA, OCTAVIO (MD)
Entity type:Individual
Prefix:
First Name:OCTAVIO
Middle Name:
Last Name:AVILA ZAMORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OCTAVIO
Other - Middle Name:
Other - Last Name:AVILA ZAMORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7853 SW 56TH ST
Mailing Address - Street 2:APT A 219
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4389
Mailing Address - Country:US
Mailing Address - Phone:786-202-5101
Mailing Address - Fax:
Practice Address - Street 1:13500 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1111
Practice Address - Country:US
Practice Address - Phone:786-596-4300
Practice Address - Fax:786-533-9267
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10043361207Q00000X
FLME123042207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine