Provider Demographics
NPI:1770347387
Name:GOMES DASILVA, CARLOS ALEXANDRE
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALEXANDRE
Last Name:GOMES DASILVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6102 WHEATLEY CT
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-9096
Mailing Address - Country:US
Mailing Address - Phone:954-478-2694
Mailing Address - Fax:
Practice Address - Street 1:6102 WHEATLEY CT
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-9096
Practice Address - Country:US
Practice Address - Phone:954-478-2694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant