Healthcare Provider Details

I. General information

NPI: 1346163250
Provider Name (Legal Business Name): CARLOS MARINO VEGA ALVAREZ SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 NE 192ND ST APT 211
AVENTURA FL
33180-2453
US

IV. Provider business mailing address

3400 NE 192ND ST APT 211
AVENTURA FL
33180-2453
US

V. Phone/Fax

Practice location:
  • Phone: 786-859-1003
  • Fax:
Mailing address:
  • Phone: 786-859-1003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number109648621
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: