MEDICARE: TAMPA BAY PEDIATRICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME84690	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	284838	OTHER	FL	AVMED
2	7189416	OTHER	FL	AETNA
3	03286	OTHER	FL	BCBS
4	4137152	OTHER	FL	CIGNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083877047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA BAY PEDIATRICS LLC

Provider Business Mailing Address
First Line	:	PO BOX 152682
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33684-2682
Country	:	US
Telephone Number	:	813-743-7879
Fax Number	:	813-926-5358

Provider Business Practice Location Address
First Line	:	2302 W DR MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6406
Country	:	US
Telephone Number	:	813-743-7879
Fax Number	:	813-926-5358

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CARLOS M CARTAYA
Credential	:	MD
Telephone Number	:	813-743-7879

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	03/07/2023

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Directions to “TAMPA BAY PEDIATRICS LLC ” Practice Location

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