Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | DN16594 | FL |
NPI | 1487769287 |
---|---|
Provider Name | Pat Ricalde |
First Address | St Pete Beach, FL 33706-2623 |
Second Address | Tampa, FL 33609-3281 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 24/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
075756001 | (05) | FL |