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General NPI Number Information
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NPI Number | 1770902405
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Entity Type | Organization
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Legal Business Name | EP MD PA
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Dates
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Enumeration Date | 04/09/2014
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Last Update Date | 04/09/2014
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Provider Practice Location Address
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Address Line | 4980 W 10TH AVE STE 101
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City | HIALEAH
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State | FL
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Zip | 33012-3437
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Country | US
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Telephone | 305-819-5583
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Fax | 305-819-5643
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Provider Business Mailing Address
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Address Line | 4980 W 10TH AVE STE 101
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City | HIALEAH
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State | FL
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Zip | 33012-3437
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Country | US
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Telephone | 305-819-5583
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Fax | 305-819-5643
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ESTILITA PASCUAL
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Credential | M.D.
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Telephone | 305-213-3238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME0063839
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License Number State | FL
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