Provider Demographics
NPI:1285233403
Name:PICART, ANGEL ROSE
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:ROSE
Last Name:PICART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12741 SW 108TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3514
Mailing Address - Country:US
Mailing Address - Phone:305-903-6620
Mailing Address - Fax:
Practice Address - Street 1:12741 SW 108TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-3514
Practice Address - Country:US
Practice Address - Phone:305-903-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program