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NPI Code Detail

MEDICARE: PAT RICALDE DDS MD

MEDICARE: PAT RICALDE DDS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1204E00000XOral & Maxillofacial Surgery (D.M.D.)DN16594FL
2174400000XSpecialistME88289FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487769287
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAT RICALDE DDS MD
Provider Business Mailing Address
First Line : 4200 N ARMENIA AVE STE 3
Second Line :
City : TAMPA
State : FL
Zip : 33607-6451
Country : US
Telephone Number : 813-870-6000
Fax Number : 813-870-6015
Provider Business Practice Location Address
First Line : 4200 N ARMENIA AVE STE 3
Second Line :
City : TAMPA
State : FL
Zip : 33607-6451
Country : US
Telephone Number : 813-870-6000
Fax Number : 813-870-6015
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2006
Last Update Date : 06/14/2022

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