Provider Demographics
NPI:1558528067
Name:VANEGAS, RICARDO HARRY (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:HARRY
Last Name:VANEGAS
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 1:10671 NW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-2311
Mailing Address - Country:US
Mailing Address - Phone:305-836-3232
Mailing Address - Fax:954-517-9658
Practice Address - Street 1:10671 NW 22ND ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-2311
Practice Address - Country:US
Practice Address - Phone:305-836-3232
Practice Address - Fax:954-517-9658
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62082207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370791100Medicaid
BV3211620OtherDEA
BV3211620OtherDEA
15256Medicare PIN