Provider Demographics
NPI:1891029104
Name:CARLOS LAROCCA, MD, PA
Entity Type:Organization
Organization Name:CARLOS LAROCCA, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAROCCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-271-4001
Mailing Address - Street 1:11130 SW 88TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-0939
Mailing Address - Country:US
Mailing Address - Phone:305-271-4001
Mailing Address - Fax:305-270-0108
Practice Address - Street 1:11130 SW 88TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-0939
Practice Address - Country:US
Practice Address - Phone:305-271-4001
Practice Address - Fax:305-270-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 82455207P00000X
FLME 53044207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048413000Medicaid
FLD51428Medicare UPIN
FL048413000Medicaid