Basic Information
| Provider Information | |||||||||
| NPI: | 1174582969 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PASCUAL | ||||||||
| FirstName: | RICARDO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4930 LAKE MARY BLVD | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327716012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073228645 | ||||||||
| FaxNumber: | 4073305074 | ||||||||
| Practice Location | |||||||||
| Address1: | 1120 STATE ROAD 436 | ||||||||
| Address2: | SUITE 1200 | ||||||||
| City: | CASSELBERRY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327076100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073228645 | ||||||||
| FaxNumber: | 4073305074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 09/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | ACN767 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 016621300 | 05 | FL | MEDICAID |