MEDICARE: CAROLINA FORTICH

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	342000000X	Transportation Network Company	F632100699070	FL

General Provider Information

NPI Number	:	1588377972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINA FORTICH

Provider Business Mailing Address
First Line	:	5417 SW 165TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-5265
Country	:	US
Telephone Number	:	786-326-3524
Fax Number	:

Provider Business Practice Location Address
First Line	:	5417 SW 165TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-5265
Country	:	US
Telephone Number	:	786-326-3524
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2022
Last Update Date	:	12/30/2022

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Directions to “ CAROLINA FORTICH ” Practice Location

Language	Start Address	Practice Location

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