Provider Demographics
NPI:1407907611
Name:ESTILITA PASCUAL MD PA
Entity Type:Organization
Organization Name:ESTILITA PASCUAL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ESTILITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PASCUAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-828-0048
Mailing Address - Street 1:1255 W 46TH ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3283
Mailing Address - Country:US
Mailing Address - Phone:305-828-0048
Mailing Address - Fax:305-828-2639
Practice Address - Street 1:1255 W 46TH ST
Practice Address - Street 2:SUITE 8
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3283
Practice Address - Country:US
Practice Address - Phone:305-828-0048
Practice Address - Fax:305-828-2639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63839208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372599500Medicaid
FLF61677Medicare UPIN
FL372599500Medicaid
FLK0065Medicare ID - Type UnspecifiedGROUP PROVIDER