Healthcare Provider Details

I. General information

NPI: 1487441630
Provider Name (Legal Business Name): CARLOS RAMON LARIOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 PALM AVE
SAINT CLOUD FL
34769-3876
US

IV. Provider business mailing address

128 PALM AVE
SAINT CLOUD FL
34769-3876
US

V. Phone/Fax

Practice location:
  • Phone: 407-624-9992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: