Provider Demographics
NPI:1932773512
Name:CIRILO, JULISSA LAURIE (MD)
Entity type:Individual
Prefix:
First Name:JULISSA
Middle Name:LAURIE
Last Name:CIRILO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 QUISQUEYA
Mailing Address - Street 2:100 RENAISSANCE SQUARE 15102
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-1315
Mailing Address - Country:US
Mailing Address - Phone:939-289-3222
Mailing Address - Fax:
Practice Address - Street 1:715 AVE PONCE DE LEON STOP 37.5
Practice Address - Street 2:
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917-5032
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15727-I390200000X
PR22917208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program