Healthcare Provider Details

I. General information

NPI: 1730165655
Provider Name (Legal Business Name): ALFREDO BERNARD CARTAYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EZEQUIEL BERNARD CARTAYA MD

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11375 CORTEZ BLVD
BROOKSVILLE FL
34613-5409
US

IV. Provider business mailing address

11161 STATE ROAD 70 E STE 110-135
LAKEWOOD RANCH FL
34202-9407
US

V. Phone/Fax

Practice location:
  • Phone: 888-258-3326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME54848
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberME54848
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberN2023
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: