1679538797 NPI number — HERNAN M CARRION M.D.

Table of content: HERNAN M CARRION M.D. (NPI 1679538797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679538797 NPI number — HERNAN M CARRION M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARRION
Provider First Name:
HERNAN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679538797
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9165 PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI SHORES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33138-3163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-545-6685
Provider Business Mailing Address Fax Number:
786-515-0254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1321 NW 14TH ST
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33125-1673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-547-2534
Provider Business Practice Location Address Fax Number:
305-326-7210
Provider Enumeration Date:
04/20/2006

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: 208800000X , with the licence number:  ME20544 , 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: 053422600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10D0877365 . This is a "CLIA NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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