Provider Demographics
NPI:1255765699
Name:CARVAJAL, STEVEN (LMT)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:CARVAJAL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 RIVERSIDE DR # B301
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-1001
Mailing Address - Country:US
Mailing Address - Phone:954-471-2829
Mailing Address - Fax:
Practice Address - Street 1:2700 RIVERSIDE DR # B301
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-1001
Practice Address - Country:US
Practice Address - Phone:954-471-2829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 33991225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1255765699OtherNPI