Healthcare Provider Details

I. General information

NPI: 1407744485
Provider Name (Legal Business Name): CARLOS AUGUSTO METIDIERI MENEOZZO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 08/25/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVENUE
MIAMI FL
33136
US

IV. Provider business mailing address

582 FRANCA PINTO ST., VILA MARIANA, POSTAL CODE 04016-0 APTO 111
SAO PAULO SAO PAULO
04016
BR

V. Phone/Fax

Practice location:
  • Phone: 305-355-1122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: