Healthcare Provider Details

I. General information

NPI: 1699359307
Provider Name (Legal Business Name): CARLOS J SAMADA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2021
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13255 SW 137TH AVE STE 206
MIAMI FL
33186-5328
US

IV. Provider business mailing address

8200 NW 27TH ST STE 108
DORAL FL
33122-1902
US

V. Phone/Fax

Practice location:
  • Phone: 786-662-3893
  • Fax: 786-662-3899
Mailing address:
  • Phone: 786-662-3893
  • Fax: 786-662-3899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO4449
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: