Basic Information
| Provider Information | |||||||||
| NPI: | 1366537011 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARIAGA | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11255 SW 211TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331892240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052780200 | ||||||||
| FaxNumber: | 7862350145 | ||||||||
| Practice Location | |||||||||
| Address1: | 11211 N NEBRASKA AVE | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336125777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8135142333 | ||||||||
| FaxNumber: | 8135142216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME55919 | FL | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | BC2111879 | 01 | FL | DEA REGISTRATION | OTHER |