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General NPI Number Information
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NPI Number | 1003904699
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Entity Type | Individual
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Provider Name | ALTAGRACIA RECIO PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 701 SW 27TH AVE
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City | MIAMI
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State | FL
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Zip | 33135-3031
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Country | US
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Telephone | 305-642-3396
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Fax | 305-642-6622
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Provider Business Mailing Address
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Address Line | 701 SW 27TH AVENUE
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City | MIAMI
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State | FL
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Zip | 33135
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Country | US
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Telephone | 305-642-3396
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Fax | 305-642-6622
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 9101967
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License Number State | FL
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