Provider Demographics
NPI:1245929512
Name:CARRERO, ARIEL (PA-C)
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:CARRERO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7934 NW 190TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2746
Mailing Address - Country:US
Mailing Address - Phone:305-525-3860
Mailing Address - Fax:
Practice Address - Street 1:4302 ALTON RD STE 220
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2818
Practice Address - Country:US
Practice Address - Phone:305-535-1891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9117125OtherFLORIDA MEDICAL LICENSE