MEDICARE: ANDRES EDUARDO CARMONA RUBIO M.D

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207RA0001X	Advanced Heart Failure and Transplant Cardiology Physician	35.140320	OH

General Provider Information

NPI Number	:	1750722781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRES EDUARDO CARMONA RUBIO M.D

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE # J3-4
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0002
Country	:	US
Telephone Number	:	216-445-5843
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE # J3-4
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-3021
Country	:	US
Telephone Number	:	216-445-5843
Fax Number	:

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

Provider Enumeration Date	:	07/05/2013
Last Update Date	:	01/26/2021

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