Provider Demographics
NPI:1861875122
Name:RICARDO ARGUELLO, M.D.
Entity type:Organization
Organization Name:RICARDO ARGUELLO, M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ARGUELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-533-6528
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006K0OtherBC/BS
FL061451300Medicaid
FL061451300Medicaid