MEDICARE: CELENA VINENT CARBONELL M.D., P.A.

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1720690704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CELENA VINENT CARBONELL M.D., P.A.

Provider Business Mailing Address
First Line	:	1001 N MACDILL AVE STE D
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-5152
Country	:	US
Telephone Number	:	813-324-5688
Fax Number	:	813-549-3229

Provider Business Practice Location Address
First Line	:	1001 N MACDILL AVE STE D
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-5152
Country	:	US
Telephone Number	:	813-324-5688
Fax Number	:	813-549-3229

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CELENA VINENT CARBONELL
Credential	:	M.D.
Telephone Number	:	813-324-5688

Provider Enumeration Date	:	08/20/2020
Last Update Date	:	08/20/2020

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