Provider Demographics
NPI:1497950315
Name:CARRODEGUAS, LESTER (MD)
Entity Type:Individual
Prefix:DR
First Name:LESTER
Middle Name:
Last Name:CARRODEGUAS
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 1:885 SW 109 AVE
Mailing Address - Street 2:SUITE 131
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33199-0001
Mailing Address - Country:US
Mailing Address - Phone:305-348-3627
Mailing Address - Fax:305-348-4261
Practice Address - Street 1:885 SW 109 AVE
Practice Address - Street 2:SUITE 131
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33199-0001
Practice Address - Country:US
Practice Address - Phone:305-348-0254
Practice Address - Fax:305-348-4261
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105604207Q00000X, 207QA0000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCY642ZMedicare PIN