Healthcare Provider Details

I. General information

NPI: 1174582969
Provider Name (Legal Business Name): RICARDO PASCUAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 STATE ROAD 436 SUITE 1200
CASSELBERRY FL
32707-6100
US

IV. Provider business mailing address

4930 LAKE MARY BLVD
SANFORD FL
32771-6012
US

V. Phone/Fax

Practice location:
  • Phone: 407-322-8645
  • Fax: 407-330-5074
Mailing address:
  • Phone: 407-322-8645
  • Fax: 407-330-5074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN767
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: