Healthcare Provider Details

I. General information

NPI: 1346864931
Provider Name (Legal Business Name): OSVALDO ANTONIO CARMONA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2020
Last Update Date: 05/31/2020
Certification Date: 05/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7031 SW 62ND AVE
SOUTH MIAMI FL
33143-4701
US

IV. Provider business mailing address

3035 SW 80TH AVE
MIAMI FL
33155-2516
US

V. Phone/Fax

Practice location:
  • Phone: 305-284-7500
  • Fax: 305-284-7657
Mailing address:
  • Phone: 941-916-8488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTRN30535
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: