Provider Demographics
NPI:1548253255
Name:ARGUELLO, RICARDO (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:ARGUELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-3343
Mailing Address - Country:US
Mailing Address - Phone:863-533-6528
Mailing Address - Fax:863-534-3641
Practice Address - Street 1:1218 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-3343
Practice Address - Country:US
Practice Address - Phone:863-533-6528
Practice Address - Fax:863-534-3641
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054345208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08963OtherBC/BS PROVIDER NUMBER
FL0622606OtherAETNA PROVIDER NUMBER
FL100435OtherAV-MED PROVIDER NUMBER
FL206547OtherAMERIGROUP PROVIDER NUMBE
FL7789150003OtherCIGNA PROVIDER NUMBER
FL01384OtherSTAYWELL PROVIDER NUMBER
FL10000701OtherCITRUS HEALTH PROVIDER
FL10000701OtherCITRUS HEALTH PROVIDER