Basic Information
| Provider Information | |||||||||
| NPI: | 1083606214 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VADILLO | ||||||||
| FirstName: | ALBERTO | ||||||||
| MiddleName: | EUSEBIO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 816759 | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330810759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056741233 | ||||||||
| FaxNumber: | 9549646084 | ||||||||
| Practice Location | |||||||||
| Address1: | 4300 ALTON RD | ||||||||
| Address2: | SUITE 2220 | ||||||||
| City: | MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331402948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056742533 | ||||||||
| FaxNumber: | 3055382960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2005 | ||||||||
| LastUpdateDate: | 03/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | ME44119 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 060056769 | 01 | PALMETTO GBA | OTHER | 064487100 | 05 | FL | MEDICAID |