Provider Demographics
NPI:1700838372
Name:ESPAILLAT, RICARDO (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:ESPAILLAT
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 1:7501 WILES RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2063
Mailing Address - Country:US
Mailing Address - Phone:954-346-8300
Mailing Address - Fax:954-346-8303
Practice Address - Street 1:7501 WILES RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2063
Practice Address - Country:US
Practice Address - Phone:954-346-8300
Practice Address - Fax:954-346-8303
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME905932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3937ZMedicare UPIN
FL3937Medicare ID - Type Unspecified
FLG79174Medicare UPIN