Healthcare Provider Details

I. General information

NPI: 1972636421
Provider Name (Legal Business Name): CARL CARROZZO A.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1641 NE 163RD ST
NORTH MIAMI BEACH FL
33162-4730
US

IV. Provider business mailing address

1641 NE 163RD ST
NORTH MIAMI BEACH FL
33162-4730
US

V. Phone/Fax

Practice location:
  • Phone: 305-949-3388
  • Fax:
Mailing address:
  • Phone: 305-949-3388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP1041
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: