Individual
JULIO LICINIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3109 GRAND AVE, SUITE 205, MIAMI, FL 33133-5103
(305) 570-7301
Mailing address
3109 GRAND AVE, # 205, MIAMI, FL 33133-5103
(305) 570-7301
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
C50445
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C504450
MEDICAL
CA
01
—
ME97202
MEDICAL
FL
Enumeration date
07/08/2006
Last updated
04/30/2014
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