Healthcare Provider Details

I. General information

NPI: 1356845598
Provider Name (Legal Business Name): OMAR ALBERTO PICADO ROQUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 W 20TH AVE STE 615
HIALEAH FL
33016-5511
US

IV. Provider business mailing address

7150 W 20TH AVE STE 615
HIALEAH FL
33016-5511
US

V. Phone/Fax

Practice location:
  • Phone: 305-820-6657
  • Fax: 305-820-6658
Mailing address:
  • Phone: 305-820-6657
  • Fax: 305-820-6658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME145680
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: