Basic Information
Provider Information | |||||||||
NPI: | 1588209894 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DO CARMO | ||||||||
FirstName: | CAROLINA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CAROLINA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8404 W SAMPLE RD APT 233 | ||||||||
Address2: |   | ||||||||
City: | CORAL SPRINGS | ||||||||
State: | FL | ||||||||
PostalCode: | 330654652 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7867075274 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1495 N PARK DR | ||||||||
Address2: |   | ||||||||
City: | WESTON | ||||||||
State: | FL | ||||||||
PostalCode: | 333263215 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9543562878 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/11/2019 | ||||||||
LastUpdateDate: | 11/11/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT1992198 | FL | N |   |   |   |   | 106S00000X | RBT-19-92198 | FL | Y |   |   |   |   |
ID Information
ID | Type | State | Issuer | Description | RBT-19-92198 | 01 | FL | BACB | OTHER |