Provider Demographics
NPI:1205935178
Name:PASCUAL, ESTILITA (MD)
Entity type:Individual
Prefix:
First Name:ESTILITA
Middle Name:
Last Name:PASCUAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 NW 107TH AVE STE G
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2734
Mailing Address - Country:US
Mailing Address - Phone:786-536-9719
Mailing Address - Fax:786-536-9847
Practice Address - Street 1:2100 W 76TH ST FL 5
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5539
Practice Address - Country:US
Practice Address - Phone:786-536-9719
Practice Address - Fax:786-536-9830
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063839208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109781900Medicaid
FLF61677Medicare UPIN
FL372599500Medicaid