Healthcare Provider Details

I. General information

NPI: 1720091960
Provider Name (Legal Business Name): EDGARDO ALICEA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: EDGARDO ALICEA MD

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13550 SW 10TH ST STE B
PEMBROKE PINES FL
33027-6445
US

IV. Provider business mailing address

8333 NW 53RD ST FL 6
DORAL FL
33166-4783
US

V. Phone/Fax

Practice location:
  • Phone: 954-433-9501
  • Fax: 954-433-8035
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME148410
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: