Provider Demographics
NPI:1932406774
Name:MARIO H. AVILA, M.D.P.A.
Entity Type:Organization
Organization Name:MARIO H. AVILA, M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:H
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-726-3606
Mailing Address - Street 1:7707 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2950
Mailing Address - Country:US
Mailing Address - Phone:954-726-3606
Mailing Address - Fax:954-726-7859
Practice Address - Street 1:7707 N UNIVERSITY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2950
Practice Address - Country:US
Practice Address - Phone:954-726-3606
Practice Address - Fax:954-726-7859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD60315Medicare UPIN