Healthcare Provider Details

I. General information

NPI: 1689585358
Provider Name (Legal Business Name): CENTERWELL SENIOR PRIMARY CARE (CARBON) PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 100
MIAMI FL
33126-2040
US

V. Phone/Fax

Practice location:
  • Phone: 305-500-2000
  • Fax:
Mailing address:
  • Phone: 305-500-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGEL GARCIA
Title or Position: BILLING DEPARTMENT
Credential:
Phone: 863-399-3251