Provider Demographics
NPI:1972009066
Name:FERREIRA, WICKANDER (MLT, LA)
Entity Type:Individual
Prefix:MR
First Name:WICKANDER
Middle Name:
Last Name:FERREIRA
Suffix:
Gender:M
Credentials:MLT, LA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 W 47TH PL STE 319
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3448
Mailing Address - Country:US
Mailing Address - Phone:862-367-1400
Mailing Address - Fax:
Practice Address - Street 1:1275 W 47TH PL STE 319
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3448
Practice Address - Country:US
Practice Address - Phone:862-367-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty