MEDICARE: DR. CARLOS ANDRES VIZCARRA PA 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	207R00000X	Internal Medicine Physician	ME 93719	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7739516	OTHER	FL	EIN

General Provider Information

NPI Number	:	1891729752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS ANDRES VIZCARRA PA M.D

Provider Business Mailing Address
First Line	:	13000 US HIGHWAY 1
Second Line	:	SUITE 4
City	:	SEBASTIAN
State	:	FL
Zip	:	32958-3773
Country	:	US
Telephone Number	:	772-589-9188
Fax Number	:	772-589-9187

Provider Business Practice Location Address
First Line	:	13000 US HIGHWAY 1
Second Line	:	SUITE 4
City	:	SEBASTIAN
State	:	FL
Zip	:	32958-3773
Country	:	US
Telephone Number	:	772-589-9188
Fax Number	:	772-589-9187

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	03/03/2015

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