Healthcare Provider Details

I. General information

NPI: 1336088350
Provider Name (Legal Business Name): RICARDO ALEJANDRO QUEVEDO RONDA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD STE 760
MIAMI BEACH FL
33140-2893
US

IV. Provider business mailing address

14853 SW 104TH ST APT 24
MIAMI FL
33196-2425
US

V. Phone/Fax

Practice location:
  • Phone: 305-501-4616
  • Fax: 305-501-4616
Mailing address:
  • Phone: 789-232-5514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPACN93
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: