Provider Demographics
NPI:1669633855
Name:CARVAJAL, MARITZA HENRIQUEZ (BS)
Entity Type:Individual
Prefix:MS
First Name:MARITZA
Middle Name:HENRIQUEZ
Last Name:CARVAJAL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10661 N KENDALL DR STE 229
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1556
Mailing Address - Country:US
Mailing Address - Phone:305-898-7588
Mailing Address - Fax:
Practice Address - Street 1:9655 SW 152ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1241
Practice Address - Country:US
Practice Address - Phone:305-898-7588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator