MEDICARE: CARLOS MAZA APRN

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	363LA2200X	Adult Health Nurse Practitioner	APRN11008730	FL
2	363LW0102X	Women's Health Nurse Practitioner	APRN11008730	FL
3	363LG0600X	Gerontology Nurse Practitioner	APRN11008730	FL

General Provider Information

NPI Number	:	1811509961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS MAZA APRN

Provider Business Mailing Address
First Line	:	7590 NW 186TH ST STE 209
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-2952
Country	:	US
Telephone Number	:	786-953-6263
Fax Number	:

Provider Business Practice Location Address
First Line	:	7590 NW 186TH ST STE 209
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-2952
Country	:	US
Telephone Number	:	786-953-6263
Fax Number	:	786-953-6891

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

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	02/12/2022

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Directions to “ CARLOS MAZA APRN” Practice Location

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