Healthcare Provider Details

I. General information

NPI: 1194657668
Provider Name (Legal Business Name): DR. CARLOS GUILLERMO PIMENTEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 MARTIN LUTHER KING JR BLVD
DETROIT MI
48208-2576
US

IV. Provider business mailing address

14233 SW 146TH AVE
MIAMI FL
33186-6792
US

V. Phone/Fax

Practice location:
  • Phone: 313-494-6606
  • Fax:
Mailing address:
  • Phone: 786-623-1175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: