Provider Demographics
NPI:1205187747
Name:WILTZ, CARLOS (PA)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:WILTZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8940 N KENDALL DR STE 101E
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2166
Mailing Address - Country:US
Mailing Address - Phone:305-520-5625
Mailing Address - Fax:305-520-5628
Practice Address - Street 1:8940 N KENDALL DR STE 101E
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2166
Practice Address - Country:US
Practice Address - Phone:305-520-5625
Practice Address - Fax:305-520-5628
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9106832363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical