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NPI Code Detail

MEDICARE: CARLA SULTAN AVILA MD

MEDICARE: CARLA SULTAN AVILA MD
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1417643008
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLA SULTAN AVILA MD
Provider Business Mailing Address
First Line : 4225 W 20TH AVE
Second Line :
City : HIALEAH
State : FL
Zip : 33012-5826
Country : US
Telephone Number : 786-828-7552
Fax Number :
Provider Business Practice Location Address
First Line : 4225 W 20TH AVE
Second Line :
City : HIALEAH
State : FL
Zip : 33012-5826
Country : US
Telephone Number : 786-828-7552
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2023
Last Update Date : 12/11/2024

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