Provider Demographics
NPI:1922620749
Name:CARMONA MEDICAL CARE INC
Entity Type:Organization
Organization Name:CARMONA MEDICAL CARE INC
Other - Org Name:CARMONA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARMONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-768-3315
Mailing Address - Street 1:2307 BOLADO PKWY
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-2712
Mailing Address - Country:US
Mailing Address - Phone:786-768-3315
Mailing Address - Fax:239-443-4516
Practice Address - Street 1:2307 BOLADO PKWY
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2712
Practice Address - Country:US
Practice Address - Phone:786-768-3315
Practice Address - Fax:239-443-4516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2DYCQOtherBCBS
FL022660000Medicaid