Provider Demographics
NPI:1396910949
Name:PASCUAL, AMARYLLIS (MD)
Entity type:Individual
Prefix:
First Name:AMARYLLIS
Middle Name:
Last Name:PASCUAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18205 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2106
Mailing Address - Country:US
Mailing Address - Phone:305-947-0751
Mailing Address - Fax:786-288-5267
Practice Address - Street 1:18205 BISCAYNE BLVD
Practice Address - Street 2:SUITE 1000
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-2106
Practice Address - Country:US
Practice Address - Phone:305-947-0751
Practice Address - Fax:786-288-5267
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL94686207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 94686Other94686