Provider Demographics
NPI:1770536690
Name:RICARDO, JAVIER (MD)
Entity type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:
Last Name:RICARDO
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 1:7000 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92030208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273137100Medicaid
FL28825OtherBCBS
FL273137100Medicaid
FL28825OtherBCBS