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General NPI Number Information
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NPI Number | 1649409319
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Entity Type | Organization
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Legal Business Name | ISABEL M CARVAJAL OD PA
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 08/05/2010
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Provider Practice Location Address
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Address Line | 11605 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-4109
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Country | US
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Telephone | 954-438-2428
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Fax | 954-438-2450
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Provider Business Mailing Address
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Address Line | 5140 STAGECOACH DR
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City | COCONUT CREEK
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State | FL
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Zip | 33073-2242
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Country | US
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Telephone | 954-438-2428
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Fax | 954-438-2429
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Authorized Official
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Title or Position | PRESIDENT OPTOMETRIST
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Name | ISABEL M CARVAJAL
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Credential | OD
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Telephone | 954-873-4130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC4213
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License Number State | FL
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