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General NPI Number Information
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NPI Number | 1902167885
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Entity Type | Individual
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Provider Name | CARLA ALEXIS DE VENECIA M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 12/22/2020
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Provider Practice Location Address
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Address Line | 125 METRO CENTER BLVD STE 2000
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City | WARWICK
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State | RI
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Zip | 02886-1785
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Country | US
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Telephone | 401-921-9202
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Fax | 401-921-9212
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Provider Business Mailing Address
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Address Line | 125 METRO CENTER BLVD. SUITE 2000
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City | WARWICK
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State | RI
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Zip | 02886-1785
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Country | US
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Telephone | 401-921-9202
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Fax | 603-668-0164
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD17272
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 285931
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 16998
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License Number State | NH
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