Provider Demographics
NPI:1902358492
Name:SARMIENTO RODRIGUEZ, CARLOS A
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:A
Last Name:SARMIENTO RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9839 SW 222ND ST
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1515
Mailing Address - Country:US
Mailing Address - Phone:917-826-8242
Mailing Address - Fax:
Practice Address - Street 1:9839 SW 222ND ST
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1515
Practice Address - Country:US
Practice Address - Phone:917-826-8242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16671246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant