Provider Demographics
NPI:1700852522
Name:CASO, CARLOS NICOLAS (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:NICOLAS
Last Name:CASO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SAN REMO AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3043
Mailing Address - Country:US
Mailing Address - Phone:786-595-3711
Mailing Address - Fax:786-533-9556
Practice Address - Street 1:COUNTRY WALK URGENT CARE EXPRESS
Practice Address - Street 2:15721 SW 152ND ST
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-1347
Practice Address - Country:US
Practice Address - Phone:786-595-3711
Practice Address - Fax:786-533-9556
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZPA9112159363A00000X
WAPA10004439363AS0400X
FLPA9112159363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8360232Medicaid
WAQ60041Medicare UPIN
WA8857838Medicare PIN