1225263890 NPI number — EDUARDO CARMONA MD PA

Table of content: (NPI 1225263890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225263890 NPI number — EDUARDO CARMONA MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDUARDO CARMONA MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1225263890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 510083
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUNTA GORDA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33951-0083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-815-0316
Provider Business Mailing Address Fax Number:
941-347-7282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20020 VETERANS BLVD
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
PORT CHARLOTTE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33954-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-815-0316
Provider Business Practice Location Address Fax Number:
941-347-7282
Provider Enumeration Date:
05/26/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CARMONA
Authorized Official First Name:
EDUARDO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
941-815-0316

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  ME98606 , 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)





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