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General NPI Number Information
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NPI Number | 1578223590
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Entity Type | Individual
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Provider Name | MARCOS JOSE CARVAJAL BERMEJO DNP, PMHNP-BC, APRN
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Gender | Male
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Dates
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Enumeration Date | 12/20/2021
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 16430 NW 59TH AVE STE 202
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City | MIAMI LAKES
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State | FL
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Zip | 33014-5605
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Country | US
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Telephone | 754-201-5811
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Fax |
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Provider Business Mailing Address
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Address Line | 16430 NW 59TH AVE STE 202
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City | MIAMI LAKES
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State | FL
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Zip | 33014-5605
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Country | US
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Telephone | 786-638-1508
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | APRN11017076
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11017076
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License Number State | FL
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