Healthcare Provider Details

I. General information

NPI: 1215064803
Provider Name (Legal Business Name): MS. NATALIE CARRIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 NW 167TH ST SUITE #102
OPA LOCKA FL
33056-4838
US

IV. Provider business mailing address

20250 NE 3RD CT
MIAMI FL
33179-5203
US

V. Phone/Fax

Practice location:
  • Phone: 305-624-7450
  • Fax: 305-623-7893
Mailing address:
  • Phone: 305-624-7450
  • Fax: 305-623-7893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: