MEDICARE: CARLOS F VALLEJO MD PA

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	207R00000X	Internal Medicine Physician	ME0069920	FL

General Provider Information

NPI Number	:	1740595339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLOS F VALLEJO MD PA

Provider Business Mailing Address
First Line	:	5803 NW 151ST ST
Second Line	:	STE 101
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2473
Country	:	US
Telephone Number	:	305-696-8802
Fax Number	:	305-696-8156

Provider Business Practice Location Address
First Line	:	5803 NW 151ST ST
Second Line	:	STE 101
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2473
Country	:	US
Telephone Number	:	305-696-8802
Fax Number	:	305-696-8156

Authorized Official
Title or Position	:	MEDICAL DOCTOR/PRESIDENT
Name	:	CARLOS F VALLEJO
Credential	:	M.D.
Telephone Number	:	305-696-8802

Provider Enumeration Date	:	08/09/2010
Last Update Date	:	11/18/2013

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