Healthcare Provider Details

I. General information

NPI: 1043565062
Provider Name (Legal Business Name): CARLOS VINAS PALOMINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 SE FEDERAL HWY
HOBE SOUND FL
33455-5213
US

IV. Provider business mailing address

PO BOX 417
STUART FL
34995-0417
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-4943
  • Fax: 772-546-8345
Mailing address:
  • Phone: 772-223-2832
  • Fax: 772-223-5653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME116006
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: