1518137744 NPI number — CAROLE CAKOV PSYDPA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518137744 NPI number — CAROLE CAKOV PSYDPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLE CAKOV PSYDPA
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:
1518137744
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 5TH ST
Provider Second Line Business Mailing Address:
SUITE 228
Provider Business Mailing Address City Name:
MIAMI BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33139-6508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-776-2457
Provider Business Mailing Address Fax Number:
305-704-3092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 5TH ST
Provider Second Line Business Practice Location Address:
SUITE 228
Provider Business Practice Location Address City Name:
MIAMI BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33139-6508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-776-2457
Provider Business Practice Location Address Fax Number:
305-704-3092
Provider Enumeration Date:
03/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CAKOV
Authorized Official First Name:
CAROLE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-776-2457

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  PY6837 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: PY6837 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 688178579 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com