Healthcare Provider Details

I. General information

NPI: 1417129347
Provider Name (Legal Business Name): LUIS FRANCISCO CAICEDO OQUENDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 BISCAYNE BLVD SUITE 314
MIAMI FL
33137-3779
US

IV. Provider business mailing address

3915 BISCAYNE BLVD SUITE 314
MIAMI FL
33137-3779
US

V. Phone/Fax

Practice location:
  • Phone: 305-571-8739
  • Fax: 305-571-8706
Mailing address:
  • Phone: 305-571-8739
  • Fax: 305-571-8706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberD0067301
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberME112035
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: