Provider Demographics
NPI:1932492253
Name:VENEGAS, CARMEN MARIA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:MARIA
Last Name:VENEGAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:M
Other - Last Name:VENEGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:2385 SW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2507
Mailing Address - Country:US
Mailing Address - Phone:786-230-7896
Mailing Address - Fax:
Practice Address - Street 1:2385 SW 20TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2507
Practice Address - Country:US
Practice Address - Phone:786-230-7896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA55478305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service