Provider Demographics
NPI:1992724538
Name:SMITH, CARLOS ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ALBERTO
Last Name:SMITH
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:PO BOX 10030
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-0030
Mailing Address - Country:US
Mailing Address - Phone:386-274-7800
Mailing Address - Fax:386-274-7801
Practice Address - Street 1:1907 BORDER AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3606
Practice Address - Country:US
Practice Address - Phone:844-443-6246
Practice Address - Fax:833-907-2235
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA173466207P00000X
FLME93609207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL212699OtherAMERIGROUP
FL273131200Medicaid
FL29843OtherBLUE CROSS OF FLORIDA
P00236143Medicare PIN
FL212699OtherAMERIGROUP
FLU5428ZMedicare PIN