Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | G058296 | CA |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | ME0062590 | FL |
NPI | 1255326179 |
---|---|
Provider Name | Carlos Jesus Lavernia |
First Address | Coral Gables, FL 33114-1028 |
Second Address | Miami, FL 33129-2338 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2005 |
Last Update Date | 02/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E94084 | (02) | FL |