Healthcare Provider Details

I. General information

NPI: 1780821462
Provider Name (Legal Business Name): MARIO IGNACIO PASCUAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 N KENDALL DR STE 600W
MIAMI FL
33176-2144
US

IV. Provider business mailing address

PO BOX 198054
ATLANTA GA
30384-8054
US

V. Phone/Fax

Practice location:
  • Phone: 786-204-4204
  • Fax: 305-412-3505
Mailing address:
  • Phone: 786-204-4204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME116085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: