Provider Demographics
NPI:1417649575
Name:CARBON HEALTH MEDICAL GROUP OF FLORIDA PA
Entity Type:Organization
Organization Name:CARBON HEALTH MEDICAL GROUP OF FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-894-1718
Mailing Address - Street 1:2100 FRANKLIN ST STE 355
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8724 LAKE WORTH RD UNIT 600
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2425
Practice Address - Country:US
Practice Address - Phone:561-867-8091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care