Provider Demographics
NPI:1508084187
Name:CARTAS, IDALBERTO (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:IDALBERTO
Middle Name:
Last Name:CARTAS
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14913 SW 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3683
Mailing Address - Country:US
Mailing Address - Phone:954-662-7533
Mailing Address - Fax:
Practice Address - Street 1:3200 SW 60TH CT
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4000
Practice Address - Country:US
Practice Address - Phone:305-662-8320
Practice Address - Fax:305-665-2467
Is Sole Proprietor?:No
Enumeration Date:2007-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9101443363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical