=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669029906
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARTA MD, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2019
-----------------------------------------------------
Last Update Date | 08/21/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 717 PONCE DE LEON BLVD STE 208
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-2048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-733-5887
-----------------------------------------------------
Fax | 786-364-1056
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 717 PONCE DE LEON BLVD STE 208
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-2048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-733-5887
-----------------------------------------------------
Fax | 786-364-1056
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TAMARA ZEC
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 305-733-5887
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------