Healthcare Provider Details

I. General information

NPI: 1073195202
Provider Name (Legal Business Name): CARMEN FOUBELO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NW 79TH AVE STE 184
DORAL FL
33122-1083
US

IV. Provider business mailing address

2500 NW 79TH AVE STE 184
DORAL FL
33122-1083
US

V. Phone/Fax

Practice location:
  • Phone: 305-898-4533
  • Fax:
Mailing address:
  • Phone: 305-898-4533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11002071
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: