Provider Demographics
NPI:1427677319
Name:PASSQUAL, INC.
Entity type:Organization
Organization Name:PASSQUAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENDRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ PASCUAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-898-5440
Mailing Address - Street 1:18300 NW 62ND AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33015-8207
Mailing Address - Country:US
Mailing Address - Phone:786-677-9922
Mailing Address - Fax:844-895-3066
Practice Address - Street 1:18300 NW 62ND AVE STE 210
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33015-8207
Practice Address - Country:US
Practice Address - Phone:786-677-9922
Practice Address - Fax:844-895-3066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112158400Medicaid