Healthcare Provider Details

I. General information

NPI: 1811509961
Provider Name (Legal Business Name): CARLOS MAZA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 02/12/2022
Certification Date: 02/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7590 NW 186TH ST STE 209
HIALEAH FL
33015-2952
US

IV. Provider business mailing address

7590 NW 186TH ST STE 209
HIALEAH FL
33015-2952
US

V. Phone/Fax

Practice location:
  • Phone: 786-953-6263
  • Fax: 786-953-6891
Mailing address:
  • Phone: 786-953-6263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11008730
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN11008730
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11008730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: