Basic Information
| Provider Information | |||||||||
| NPI: | 1770202525 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARBON HEALTH PRIMARY CARE OF FLORIDA PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 FRANKLIN ST STE 355 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946123140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8442347741 | ||||||||
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| Practice Location | |||||||||
| Address1: | 446 N CAMPBELL AVE STE 130 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857195660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203053900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2022 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | PAPA | ||||||||
| AuthorizedOfficialFirstName: | GIANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6178941718 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CARBON HEALTH PRIMARY CARE OF FLORIDA PA | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.