Provider Demographics
NPI:1720392707
Name:LUCILLE FRIAL-CARRASCO DOPA
Entity Type:Organization
Organization Name:LUCILLE FRIAL-CARRASCO DOPA
Other - Org Name:MARGATE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIAL-CARRASCO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-533-7614
Mailing Address - Street 1:7200 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2148
Mailing Address - Country:US
Mailing Address - Phone:954-533-7614
Mailing Address - Fax:954-533-7714
Practice Address - Street 1:7200 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-2148
Practice Address - Country:US
Practice Address - Phone:954-533-7614
Practice Address - Fax:954-533-7714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7686208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH41179Medicare UPIN