=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376869164
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARLOS Y BREA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2010
-----------------------------------------------------
Last Update Date | 07/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 VIA BELLA BLVD STE 205
-----------------------------------------------------
City | LAND O LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34639-5429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-894-2600
-----------------------------------------------------
Fax | 813-377-1738
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 38135 MARKET SQUARE DR
-----------------------------------------------------
City | ZEPHYRHILLS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33542-7505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-567-0188
-----------------------------------------------------
Fax | 813-355-5101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | ME106647
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME106647
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------