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General NPI Number Information
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NPI Number | 1639314354
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Entity Type | Organization
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Legal Business Name | CAROLINE C HONCULADA M D LLC
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Dates
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Enumeration Date | 12/09/2008
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Last Update Date | 06/20/2012
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Provider Practice Location Address
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Address Line | 425 S 11TH ST SUITE 1
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City | LAKE WALES
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State | FL
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Zip | 33853-4342
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Country | US
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Telephone | 863-679-9494
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Fax | 863-679-8866
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Provider Business Mailing Address
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Address Line | 425 S 11TH ST SUITE 1
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City | LAKE WALES
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State | FL
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Zip | 33853-4239
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Country | US
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Telephone | 863-679-9494
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Fax | 863-679-8866
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Authorized Official
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Title or Position | OWNER
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Name | DR. CAROLINE C HONCULADA
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Credential | M D
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Telephone | 863-679-9494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME0073068
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License Number State | FL
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