Provider Demographics
NPI:1174582969
Name:PASCUAL, RICARDO (MD)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:PASCUAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 LAKE MARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6012
Mailing Address - Country:US
Mailing Address - Phone:407-322-8645
Mailing Address - Fax:407-330-5074
Practice Address - Street 1:1120 STATE ROAD 436
Practice Address - Street 2:SUITE 1200
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-6100
Practice Address - Country:US
Practice Address - Phone:407-322-8645
Practice Address - Fax:407-330-5074
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN767208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016621300Medicaid
FLACN767OtherFLORIDA STATE LICENSE
PRDM118216OtherSTATE NARCOTICS LIC
PRBP4933417OtherDEA REGISTRATION
PRBP4933417OtherDEA REGISTRATION
FLACN767OtherFLORIDA STATE LICENSE