Provider Demographics
NPI:1396487476
Name:CARRARO, PAULA PENZIN
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:PENZIN
Last Name:CARRARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15604 SW 82ND CT
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-2231
Mailing Address - Country:US
Mailing Address - Phone:786-356-8929
Mailing Address - Fax:
Practice Address - Street 1:925 NE 30TH TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7613
Practice Address - Country:US
Practice Address - Phone:305-246-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-10
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant