MEDICARE: JESUS RAFAEL PICHARDO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	ACN320	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922083948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESUS RAFAEL PICHARDO MD

Provider Business Mailing Address
First Line	:	6900 TAVISTOCK LAKES BLVD STE 300
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-7592
Country	:	US
Telephone Number	:	321-758-2966
Fax Number	:	407-286-4515

Provider Business Practice Location Address
First Line	:	1130 S SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-1457
Country	:	US
Telephone Number	:	407-382-1376
Fax Number	:	321-235-3232

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	11/20/2023

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