Healthcare Provider Details

I. General information

NPI: 1033754940
Provider Name (Legal Business Name): CARLOS EDUARDO GARCIA OCASIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 04/21/2021
Certification Date: 03/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W. OAT ST. SUITE 201
KISSIMMEE FL
34741
US

IV. Provider business mailing address

720 W. OAT ST., SUITE 201
KISSIMMEE FL
34741
US

V. Phone/Fax

Practice location:
  • Phone: 321-697-1730
  • Fax:
Mailing address:
  • Phone: 321-697-1730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: