Healthcare Provider Details

I. General information

NPI: 1578000972
Provider Name (Legal Business Name): ESTAPE GYNECOLOGIC ONCOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8585 SUNSET DR SUITE 202
MIAMI FL
33143-3746
US

IV. Provider business mailing address

8585 SUNSET DR SUITE 202
MIAMI FL
33143-3746
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-1811
  • Fax: 305-666-1801
Mailing address:
  • Phone: 305-666-1811
  • Fax: 305-666-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberME65373
License Number StateFL

VIII. Authorized Official

Name: RICARDO E ESTAPE
Title or Position: OWNER
Credential: M.D.
Phone: 305-666-1811