MEDICARE: EDGAR CARMONA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332S00000X	Hearing Aid Equipment	80571	TX

General Provider Information

NPI Number	:	1407334980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDGAR CARMONA

Provider Business Mailing Address
First Line	:	PO BOX 210151
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-0151
Country	:	US
Telephone Number	:	972-788-5968
Fax Number	:

Provider Business Practice Location Address
First Line	:	2426 W KIEST BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75233-2306
Country	:	US
Telephone Number	:	972-878-5968
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2018
Last Update Date	:	09/02/2023

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Directions to “ EDGAR CARMONA ” Practice Location

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