Healthcare Provider Details

I. General information

NPI: 1598146474
Provider Name (Legal Business Name): HECTOR L DI CARLO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 S ANDREWS AVE
FORT LAUDERDALE FL
33316-1837
US

IV. Provider business mailing address

1321 S ANDREWS AVE
FORT LAUDERDALE FL
33316-1837
US

V. Phone/Fax

Practice location:
  • Phone: 954-533-1173
  • Fax: 954-533-0723
Mailing address:
  • Phone: 954-533-1173
  • Fax: 964-533-0723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME102570
License Number StateFL

VIII. Authorized Official

Name: DR. HECTOR LUIS DI CARLO
Title or Position: PRESIDENT
Credential: MD
Phone: 954-533-1173