Provider Demographics
NPI:1245663640
Name:IZQUIERDO, CARLOS JULIO (LDO)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:JULIO
Last Name:IZQUIERDO
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 SW 38TH AVE
Mailing Address - Street 2:1302
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1531
Mailing Address - Country:US
Mailing Address - Phone:786-554-8660
Mailing Address - Fax:
Practice Address - Street 1:3824 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3002
Practice Address - Country:US
Practice Address - Phone:305-961-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO6397156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician