Healthcare Provider Details

I. General information

NPI: 1730707522
Provider Name (Legal Business Name): CARLOS RODRIGO CARRACEDO URIBE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N 35TH AVE STE 330
HOLLYWOOD FL
33021-5488
US

IV. Provider business mailing address

2900 CORPORATE WAY # D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-4325
  • Fax: 954-981-3872
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME182501
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: