Provider Demographics
NPI:1467142216
Name:MATTHEWS, CARLOS LYDELL
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:LYDELL
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11351 SW 29TH ST APT 102
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-8167
Mailing Address - Country:US
Mailing Address - Phone:754-220-0953
Mailing Address - Fax:
Practice Address - Street 1:11351 SW 29TH ST APT 102
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-8167
Practice Address - Country:US
Practice Address - Phone:754-220-0953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide