Provider Demographics
NPI:1013184712
Name:CHARLOTTE A GARZON D C P A
Entity Type:Organization
Organization Name:CHARLOTTE A GARZON D C P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALESSANDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-463-9697
Mailing Address - Street 1:2406 NW 87TH PL
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1201
Mailing Address - Country:US
Mailing Address - Phone:305-463-9697
Mailing Address - Fax:305-463-9699
Practice Address - Street 1:2406 NW 87TH PL
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1201
Practice Address - Country:US
Practice Address - Phone:305-463-9697
Practice Address - Fax:305-463-9699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLOTTE A GARZON D C P A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7737302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89685OtherBCBS
FL382159500Medicaid