Healthcare Provider Details

I. General information

NPI: 1255326179
Provider Name (Legal Business Name): CARLOS JESUS LAVERNIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 07/18/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SW 3RD AVE STE 600
MIAMI FL
33129-2338
US

IV. Provider business mailing address

PO BOX 141028
CORAL GABLES FL
33114-1028
US

V. Phone/Fax

Practice location:
  • Phone: 305-484-9727
  • Fax: 786-667-8723
Mailing address:
  • Phone: 305-773-3088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberG058296
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberME0062590
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: