Provider Demographics
NPI:1902332208
Name:GARRIDO, MANUEL (DPM)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:GARRIDO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 NW 27 ST
Mailing Address - Street 2:STE 108
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1902
Mailing Address - Country:US
Mailing Address - Phone:786-662-3893
Mailing Address - Fax:786-662-3899
Practice Address - Street 1:8280 NW 27 ST
Practice Address - Street 2:STE 505
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1905
Practice Address - Country:US
Practice Address - Phone:305-673-0033
Practice Address - Fax:305-673-9259
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLPO4180213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107218200Medicaid