MEDICARE: DR. ALFREDO BERNARD CARTAYA MD

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	ME54848	FL
2	2080N0001X	Neonatal-Perinatal Medicine Physician	ME54848	FL
3	2080N0001X	Neonatal-Perinatal Medicine Physician	N2023	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730165655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFREDO BERNARD CARTAYA MD

Provider Business Mailing Address
First Line	:	11161 STATE ROAD 70 E STE 110-135
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34202-9407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11375 CORTEZ BLVD
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34613-5409
Country	:	US
Telephone Number	:	888-258-3326
Fax Number	:

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	06/16/2021

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