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General NPI Number Information
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NPI Number | 1346864931
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Entity Type | Individual
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Provider Name | OSVALDO ANTONIO CARMONA MD
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Gender | Male
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Dates
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Enumeration Date | 05/30/2020
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Last Update Date | 05/31/2020
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Provider Practice Location Address
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Address Line | 7031 SW 62ND AVE
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-4701
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Country | US
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Telephone | 305-284-7500
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Fax | 305-284-7657
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Provider Business Mailing Address
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Address Line | 3035 SW 80TH AVE
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City | MIAMI
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State | FL
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Zip | 33155-2516
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Country | US
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Telephone | 941-916-8488
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | TRN30535
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License Number State | FL
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