Provider Demographics
NPI:1720021850
Name:CARVAJAL, PEDRO JOAQUIN (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:JOAQUIN
Last Name:CARVAJAL
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 1:9195 SUNSET DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3488
Mailing Address - Country:US
Mailing Address - Phone:305-598-3223
Mailing Address - Fax:305-595-2452
Practice Address - Street 1:9195 SUNSET DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3488
Practice Address - Country:US
Practice Address - Phone:305-598-3223
Practice Address - Fax:305-595-2452
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043042207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047174700Medicaid
FL255783500Medicaid
FL255783500Medicaid
FL33099Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
FL6389130001Medicare NSC
FL02866YMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE