Provider Demographics
NPI:1992725543
Name:PLASENCIA, RICARDO JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:JOSE
Last Name:PLASENCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 SW 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-4002
Mailing Address - Country:US
Mailing Address - Phone:305-665-9277
Mailing Address - Fax:305-265-1929
Practice Address - Street 1:8000 W FLAGLER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2153
Practice Address - Country:US
Practice Address - Phone:305-264-3989
Practice Address - Fax:305-265-1929
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME480522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
02115Medicare ID - Type Unspecified
D20710Medicare UPIN