Provider Demographics
NPI:1255326179
Name:LAVERNIA, CARLOS JESUS (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:JESUS
Last Name:LAVERNIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 141028
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33114-1028
Mailing Address - Country:US
Mailing Address - Phone:305-773-3088
Mailing Address - Fax:
Practice Address - Street 1:2600 SW 3RD AVE STE 600
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129-2338
Practice Address - Country:US
Practice Address - Phone:305-484-9727
Practice Address - Fax:786-667-8723
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG058296207XS0114X
FLME0062590207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLICENSEOtherME0062590
FL3711005-00Medicaid
FL3711005-00Medicaid
17935AMedicare PIN