MEDICARE: DR. CARLOS ALBERTO PENAHERRERA 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	207P00000X	Emergency Medicine Physician	ME127967	FL

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	:	1861838823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS ALBERTO PENAHERRERA M.D.

Provider Business Mailing Address
First Line	:	7900 HARBOR ISLAND DR # A1202
Second Line	:
City	:	NORTH BAY VILLAGE
State	:	FL
Zip	:	33141-4281
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7900 HARBOR ISLAND DR # A1202
Second Line	:
City	:	NORTH BAY VILLAGE
State	:	FL
Zip	:	33141-4281
Country	:	US
Telephone Number	:	908-307-7639
Fax Number	:

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

Provider Enumeration Date	:	05/17/2013
Last Update Date	:	10/23/2024

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