Provider Demographics
NPI:1922545433
Name:CARBAJAL MAMANI, SEMIRAMIS (MD)
Entity Type:Individual
Prefix:
First Name:SEMIRAMIS
Middle Name:
Last Name:CARBAJAL MAMANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SEMIRAMIS
Other - Middle Name:
Other - Last Name:CARBAJAL MAMANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 100225
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0225
Mailing Address - Country:US
Mailing Address - Phone:352-273-8737
Mailing Address - Fax:
Practice Address - Street 1:9344 SW 32ND PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-8630
Practice Address - Country:US
Practice Address - Phone:614-772-2858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-22
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME148035207R00000X, 207RS0012X
FLTRN23982207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine