Healthcare Provider Details

I. General information

NPI: 1700838372
Provider Name (Legal Business Name): RICARDO ESPAILLAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 WILES RD SUITE 105
CORAL SPRINGS FL
33067-2063
US

IV. Provider business mailing address

7501 WILES RD SUITE 105
CORAL SPRINGS FL
33067-2063
US

V. Phone/Fax

Practice location:
  • Phone: 954-346-8300
  • Fax: 954-346-8303
Mailing address:
  • Phone: 954-346-8300
  • Fax: 954-346-8303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME90593
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: