Healthcare Provider Details

I. General information

NPI: 1568993376
Provider Name (Legal Business Name): FERNANDO O. RECIO III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 08/14/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 N FEDERAL HWY STE 101
BOCA RATON FL
33487-3230
US

IV. Provider business mailing address

6200 N FEDERAL HWY STE 101
BOCA RATON FL
33487-3230
US

V. Phone/Fax

Practice location:
  • Phone: 561-997-8991
  • Fax:
Mailing address:
  • Phone: 561-997-8991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberME0143131
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: