Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PTA12304 | FL |
Y | 213ES0000X | Sports Medicine | PTA12304 | FL |
NPI | 1306404843 |
---|---|
Provider Name | Gregory Carvajal |
First Address | Miami Gardens, FL 33056-3429 |
Second Address | Miami Gardens, FL 33056-3429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2019 |
Last Update Date | 30/05/2019 |