Provider Demographics
NPI:1639570088
Name:VIERA, RICARDO (PA)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:VIERA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 142201
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33114-2201
Mailing Address - Country:US
Mailing Address - Phone:305-648-1087
Mailing Address - Fax:305-648-1088
Practice Address - Street 1:5040 NW 7TH ST
Practice Address - Street 2:SUITE 370
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3422
Practice Address - Country:US
Practice Address - Phone:305-648-1087
Practice Address - Fax:305-648-1088
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108124363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical