Active NPI
Julio Licinio, MD
- Psychiatry Physician
- Miami, FL
National Provider Identifier
1770516213
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- C50445
- Practice address
- 3109 Grand Ave
Suite 205
Miami, FL 33133-5103 - Phone
- (305) 570-7301
- NPI assigned
- Jul 8, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | C50445 | CA | Primary |
Addresses
Primary practice location
3109 Grand Ave
Suite 205
Miami, FL 33133-5103
Mailing address
3109 Grand Ave
# 205
Miami, FL 33133-5103
Phone (305) 570-7301
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00C504450 | Other | CA | MEDICAL |
| ME97202 | Other | FL | MEDICAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C50445 | CA | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Miami | Psychiatry | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398816000000",
"number": "1770516213",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3109 GRAND AVE",
"address_2": "# 205",
"city": "MIAMI",
"state": "FL",
"postal_code": "331335103",
"telephone_number": "305-570-7301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3109 GRAND AVE",
"address_2": "SUITE 205",
"city": "MIAMI",
"state": "FL",
"postal_code": "331335103",
"telephone_number": "305-570-7301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICINIO",
"first_name": "JULIO",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-08",
"last_updated": "2014-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "C50445",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL",
"identifier": "00C504450",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL",
"identifier": "ME97202",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Miami, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.