Healthcare Provider Details

I. General information

NPI: 1558141416
Provider Name (Legal Business Name): MR. CARLOS RAMON CONTRERAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 YELLOWBIRD DR
FORT MYERS FL
33913-7533
US

IV. Provider business mailing address

885 YELLOWBIRD DR
FORT MYERS FL
33913-7533
US

V. Phone/Fax

Practice location:
  • Phone: 786-779-6752
  • Fax:
Mailing address:
  • Phone: 786-779-6752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: