Provider Demographics
NPI:1376625681
Name:VERDEZA, CARLOS MARIO (MD)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:MARIO
Last Name:VERDEZA
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 1:13780 SW 26TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6302
Mailing Address - Country:US
Mailing Address - Phone:305-553-8033
Mailing Address - Fax:305-553-8013
Practice Address - Street 1:13780 SW 26TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6302
Practice Address - Country:US
Practice Address - Phone:305-553-8033
Practice Address - Fax:305-553-8013
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 97208207V00000X
FLME97208208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 97208OtherUNRESTRICTED MEDICAL LICE