Provider Demographics
NPI:1326650706
Name:PUIG, CARLOS (CBHCM)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:PUIG
Suffix:
Gender:M
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11401 SW 40TH ST STE 345
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3372
Mailing Address - Country:US
Mailing Address - Phone:305-603-7063
Mailing Address - Fax:305-603-8705
Practice Address - Street 1:1500 W CYPRESS CREEK RD STE 420
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1874
Practice Address - Country:US
Practice Address - Phone:954-807-8956
Practice Address - Fax:954-807-8957
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator