Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | ME78138 | FL |
NPI | 1003925868 |
---|---|
Provider Name | Carlos A Archilla |
First Address | Orlando, FL 32806-2944 |
Second Address | Orlando, FL 32827-7402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 12/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
256508100 | (05) | FL |
46779Y | MEDICARE (01) | |
G25309 | (02) |