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General NPI Number Information
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NPI Number | 1245663640
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Entity Type | Individual
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Provider Name | CARLOS JULIO IZQUIERDO LDO
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Gender | Male
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 03/18/2019
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Provider Practice Location Address
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Address Line | 3824 SW 8TH ST
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City | CORAL GABLES
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State | FL
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Zip | 33134-3002
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Country | US
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Telephone | 305-961-1060
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Fax |
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Provider Business Mailing Address
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Address Line | 3150 SW 38TH AVE 1302
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City | CORAL GABLES
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State | FL
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Zip | 33146-1531
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Country | US
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Telephone | 786-554-8660
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO6397
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License Number State | FL
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