Provider Demographics
NPI:1518388156
Name:CARLOS H NOUSARI PA
Entity Type:Organization
Organization Name:CARLOS H NOUSARI PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:H
Authorized Official - Last Name:NOUSARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:754-206-4432
Mailing Address - Street 1:5200 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5316
Mailing Address - Country:US
Mailing Address - Phone:754-206-4432
Mailing Address - Fax:954-900-2797
Practice Address - Street 1:5200 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-5316
Practice Address - Country:US
Practice Address - Phone:754-206-4432
Practice Address - Fax:954-900-2797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-28
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty