Provider Demographics
NPI:1780821462
Name:PASCUAL, MARIO IGNACIO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:IGNACIO
Last Name:PASCUAL
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:PO BOX 198054
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8054
Mailing Address - Country:US
Mailing Address - Phone:786-204-4204
Mailing Address - Fax:
Practice Address - Street 1:8950 N KENDALL DR STE 600W
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2144
Practice Address - Country:US
Practice Address - Phone:786-204-4204
Practice Address - Fax:305-412-3505
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116085207RC0001X, 207RC0001X
FLTR18496390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012075500Medicaid
FL012075500Medicaid