Healthcare Provider Details

I. General information

NPI: 1710401419
Provider Name (Legal Business Name): JOSE ANGEL CARRAZANA CAMACHO RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9974 SW 152ND TER
MIAMI FL
33157-1684
US

IV. Provider business mailing address

9974 SW 152ND TER
MIAMI FL
33157-1684
US

V. Phone/Fax

Practice location:
  • Phone: 305-951-0390
  • Fax:
Mailing address:
  • Phone: 305-951-0390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2622
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: