1528068715 NPI number — DR. MARLENE PATRICIA CARBONELL D.O.

Table of content: DR. MARLENE PATRICIA CARBONELL D.O. (NPI 1528068715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528068715 NPI number — DR. MARLENE PATRICIA CARBONELL D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARBONELL
Provider First Name:
MARLENE
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528068715
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8900 N KENDALL DR
Provider Second Line Business Mailing Address:
RADIOLOGY ASSOCIATES SOUTH FLORIDA
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33176-2118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
178-659-6591
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8900 N KENDALL DR
Provider Second Line Business Practice Location Address:
RADIOLOGY ASSOCIATES OF SOUTH FLORIDA
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-596-5917
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  OS 7955 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: OS7955 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 260031500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104008700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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