Provider Demographics
NPI:1386861052
Name:CARLOS M VERDEZA MD PA
Entity Type:Organization
Organization Name:CARLOS M VERDEZA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:VERDEZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-553-8033
Mailing Address - Street 1:13780 SW 26TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6302
Mailing Address - Country:US
Mailing Address - Phone:305-553-8033
Mailing Address - Fax:305-553-8013
Practice Address - Street 1:13780 SW 26TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6302
Practice Address - Country:US
Practice Address - Phone:305-553-8033
Practice Address - Fax:305-553-8013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97208174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 97208OtherUNRESTRICTED MEDICAL LICE