Provider Demographics
NPI:1801853692
Name:DE LERMA, CARMEN LUZ (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN LUZ
Middle Name:
Last Name:DE LERMA
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:6200 SW 73RD ST
Mailing Address - Street 2:SMH CHILD DEVELOPMENT CENTER
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4679
Mailing Address - Country:US
Mailing Address - Phone:786-662-5080
Mailing Address - Fax:786-662-5081
Practice Address - Street 1:6200 SW 73RD ST
Practice Address - Street 2:SMH CHILD DEVELOPMENT CENTER
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4679
Practice Address - Country:US
Practice Address - Phone:786-662-5080
Practice Address - Fax:786-662-5081
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 0054080208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F 15044Medicare UPIN