=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629085808
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMUEL CARRANZA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10,000 BAY PINES BOULEVARD 111A
-----------------------------------------------------
City | BAY PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-398-6661
-----------------------------------------------------
Fax | 727-398-9549
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10,000 BAY PINES BOULEVARD 111A
-----------------------------------------------------
City | BAY PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-398-6661
-----------------------------------------------------
Fax | 727-398-9549
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | ME 53173
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------