Provider Demographics
NPI:1265424097
Name:LAROCCA, CARLOS MIGUEL (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:MIGUEL
Last Name:LAROCCA
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 1:11130 N KENDALL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-0939
Mailing Address - Country:US
Mailing Address - Phone:305-271-4001
Mailing Address - Fax:305-270-0108
Practice Address - Street 1:11130 N KENDALL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-0939
Practice Address - Country:US
Practice Address - Phone:305-271-4001
Practice Address - Fax:305-270-0108
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053044207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048413000Medicaid
FL048413000Medicaid
FLFL011AMedicare UPIN
FLD51428Medicare UPIN