Healthcare Provider Details

I. General information

NPI: 1457305880
Provider Name (Legal Business Name): CARMEN R URIBE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15122 SW 72ND ST
MIAMI FL
33193-3228
US

IV. Provider business mailing address

6638 SW 112TH CT
MIAMI FL
33173-1976
US

V. Phone/Fax

Practice location:
  • Phone: 305-383-3848
  • Fax: 305-383-7601
Mailing address:
  • Phone: 305-383-3848
  • Fax: 305-383-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0034811
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME34811
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: