1619917374 NPI number — DR. ROSEMARY ANNE CARRERA OD

Table of content: DR. ROSEMARY ANNE CARRERA OD (NPI 1619917374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619917374 NPI number — DR. ROSEMARY ANNE CARRERA OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARRERA
Provider First Name:
ROSEMARY
Provider Middle Name:
ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GONZALEZ
Provider Other First Name:
ROSEMARY
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619917374
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 ALHAMBRA CIR APT 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAL GABLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33134-4660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-498-6647
Provider Business Mailing Address Fax Number:
305-265-5276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8100 CORAL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33155-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-265-7676
Provider Business Practice Location Address Fax Number:
305-265-5276
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152WL0500X , with the licence number:  4027 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 621129100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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