Provider Demographics
NPI:1255355665
Name:JAVIER RICARDO MD PA
Entity type:Organization
Organization Name:JAVIER RICARDO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:RICARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-302-7257
Mailing Address - Street 1:7000 W 12TH AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5154
Mailing Address - Country:US
Mailing Address - Phone:305-267-6774
Mailing Address - Fax:305-267-8482
Practice Address - Street 1:7000 W 12TH AVE STE 12
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-5154
Practice Address - Country:US
Practice Address - Phone:305-267-6774
Practice Address - Fax:305-267-8482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92030208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273137100Medicaid
FL273137100Medicaid
FLK8228Medicare PIN