Healthcare Provider Details

I. General information

NPI: 1487847604
Provider Name (Legal Business Name): ANGEL CARRASCO, M.D.P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 NW 7TH ST SUITE 206
MIAMI FL
33126
US

IV. Provider business mailing address

7200 NW 7TH ST SUITE 206
MIAMI FL
33126
US

V. Phone/Fax

Practice location:
  • Phone: 305-266-0222
  • Fax: 305-266-0848
Mailing address:
  • Phone: 305-266-0222
  • Fax: 305-266-0848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0005X
TaxonomyNeurodevelopmental Disabilities Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGEL CARRASCO
Title or Position: PRESIDENT
Credential: M.D.P,A.
Phone: 305-266-0222