Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 94-08685 | KS |
Y | 2080P0203X | Pediatric Critical Care Doctor | 0102206673 | VA |
NPI | 1023498052 |
---|---|
Provider Name | Carlos Carmona |
First Address | Richmond, VA 23298 |
Second Address | Richmond, VA 23298 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2015 |
Last Update Date | 28/07/2021 |