Healthcare Provider Details

I. General information

NPI: 1558298513
Provider Name (Legal Business Name): CARMEN ARIAS TABARES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SW 22ND ST STE 420
MIAMI FL
33145-2784
US

IV. Provider business mailing address

228 NW 58TH CT
MIAMI FL
33126-4726
US

V. Phone/Fax

Practice location:
  • Phone: 305-603-8517
  • Fax:
Mailing address:
  • Phone: 786-636-7284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2809
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: