Healthcare Provider Details

I. General information

NPI: 1407764749
Provider Name (Legal Business Name): CARLOS ALBERTO CARRENO RUZA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 SE 24TH ST
OCALA FL
34471-5360
US

IV. Provider business mailing address

426 SE 24TH ST
OCALA FL
34471-5360
US

V. Phone/Fax

Practice location:
  • Phone: 352-233-0463
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003101
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: