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General NPI Number Information
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NPI Number | 1700852522
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Entity Type | Individual
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Provider Name | CARLOS NICOLAS CASO PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | COUNTRY WALK URGENT CARE EXPRESS 15721 SW 152ND ST
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City | MIAMI
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State | FL
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Zip | 33187-1347
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Country | US
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Telephone | 786-595-3711
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Fax | 786-533-9556
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Provider Business Mailing Address
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Address Line | 1500 SAN REMO AVE
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City | CORAL GABLES
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State | FL
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Zip | 33146-3043
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Country | US
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Telephone | 786-595-3711
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Fax | 786-533-9556
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9112159
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License Number State | ZZ
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA10004439
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9112159
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License Number State | FL
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