MEDICARE: LUCILLE FRIAL-CARRASCO DOPA

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	208D00000X	General Practice Physician	OS7686	FL

General Provider Information

NPI Number	:	1720392707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCILLE FRIAL-CARRASCO DOPA

Provider Business Mailing Address
First Line	:	7200 W COMMERCIAL BLVD
Second Line	:	SUITE 201
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-2148
Country	:	US
Telephone Number	:	954-533-7614
Fax Number	:	954-533-7714

Provider Business Practice Location Address
First Line	:	7200 W COMMERCIAL BLVD
Second Line	:	SUITE 201
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-2148
Country	:	US
Telephone Number	:	954-533-7614
Fax Number	:	954-533-7714

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	DR. LUCILLE FRIAL-CARRASCO
Credential	:	D.O.
Telephone Number	:	954-533-7614

Provider Enumeration Date	:	08/02/2010
Last Update Date	:	08/02/2010

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