Healthcare Provider Details

I. General information

NPI: 1619833787
Provider Name (Legal Business Name): CARLOS OCASIO LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

726 MANN CIR E APT 103
MEMPHIS TN
38103-4542
US

IV. Provider business mailing address

726 MANN CIR E APT 103
MEMPHIS TN
38103-4542
US

V. Phone/Fax

Practice location:
  • Phone: 786-566-0804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2971
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: