Provider Demographics
NPI:1760198303
Name:LAVACCA, CARALIN (LE, CCE, CME)
Entity Type:Individual
Prefix:
First Name:CARALIN
Middle Name:
Last Name:LAVACCA
Suffix:
Gender:F
Credentials:LE, CCE, CME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N MAGNOLIA AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3844
Mailing Address - Country:US
Mailing Address - Phone:321-800-2922
Mailing Address - Fax:
Practice Address - Street 1:801 N MAGNOLIA AVE STE 403
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3844
Practice Address - Country:US
Practice Address - Phone:407-702-9179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFB9785904225500000X
FLEO4856225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist