Provider Demographics
NPI:1780772178
Name:GARRIDO, ANGEL ERNESTO (MD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:ERNESTO
Last Name:GARRIDO
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 1:10685 N KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1510
Mailing Address - Country:US
Mailing Address - Phone:305-514-5300
Mailing Address - Fax:305-514-5201
Practice Address - Street 1:351 NW 42ND AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5683
Practice Address - Country:US
Practice Address - Phone:305-631-8876
Practice Address - Fax:305-631-0556
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-0042052174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040566300Medicaid
FL040566300Medicaid