Provider Demographics
NPI:1194267773
Name:DANET PICO-LARRALDE MD PA
Entity type:Organization
Organization Name:DANET PICO-LARRALDE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANET
Authorized Official - Middle Name:
Authorized Official - Last Name:PICO-LARRALDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-608-3910
Mailing Address - Street 1:8785 SW 165TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5826
Mailing Address - Country:US
Mailing Address - Phone:786-828-7171
Mailing Address - Fax:786-391-4582
Practice Address - Street 1:8785 SW 165TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5826
Practice Address - Country:US
Practice Address - Phone:786-828-7171
Practice Address - Fax:786-391-4582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99952207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty