Provider Demographics
NPI:1154437028
Name:VACA, CARLOS ERNESTO (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ERNESTO
Last Name:VACA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8260 W FLAGLER ST STE 2H
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2069
Mailing Address - Country:US
Mailing Address - Phone:305-229-0551
Mailing Address - Fax:305-229-1823
Practice Address - Street 1:8260 W FLAGLER ST STE 2H
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2069
Practice Address - Country:US
Practice Address - Phone:305-229-0551
Practice Address - Fax:305-229-1823
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67188207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26264Medicare ID - Type Unspecified
F90266Medicare UPIN