=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245522937
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICARDO E PRESAS MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2011
-----------------------------------------------------
Last Update Date | 10/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13055 SW 42ND ST SUITE 101-102
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-3406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-228-8380
-----------------------------------------------------
Fax | 305-228-8371
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13055 SW 42ND ST SUITE 101-102
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-3406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-228-8380
-----------------------------------------------------
Fax | 305-228-8371
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RICARDO E PRESAS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-228-8380
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | ME67165
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------