Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | ||
N | 363LF0000X | Nurse Practitioner - Family Medicine | 11003189 | FL |
NPI | 1003235953 |
---|---|
Provider Name | Marianela Carvajal |
First Address | Miami, FL 33136-2107 |
Second Address | Miami, FL 33136-2107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2014 |
Last Update Date | 06/08/2019 |