Provider Demographics
NPI:1891729125
Name:CARRASCO, ANGEL M (MD)
Entity Type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:M
Last Name:CARRASCO
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 1:5960 NW 7TH ST
Mailing Address - Street 2:SUITE # C
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2948
Mailing Address - Country:US
Mailing Address - Phone:305-266-0222
Mailing Address - Fax:305-266-0848
Practice Address - Street 1:5960 NW 7TH ST
Practice Address - Street 2:SUITE # C
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3155
Practice Address - Country:US
Practice Address - Phone:305-266-0222
Practice Address - Fax:305-266-0848
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82190207R00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04485OtherBC/BS
FL265050900Medicaid
FL04485Medicare PIN
FL04485VMedicare PIN
FL265050900Medicaid