Provider Demographics
NPI:1316049802
Name:CARINO CAIDIC, ADELA D (MD)
Entity type:Individual
Prefix:DR
First Name:ADELA
Middle Name:D
Last Name:CARINO CAIDIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2709
Mailing Address - Country:US
Mailing Address - Phone:386-947-3553
Mailing Address - Fax:386-239-6189
Practice Address - Street 1:431 SOUTH KEECH ST
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4623
Practice Address - Country:US
Practice Address - Phone:386-947-3553
Practice Address - Fax:386-239-6189
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61222208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371289303Medicaid
FLME61223OtherSTATE MEDICAL LICENSE
FLME61223OtherSTATE MEDICAL LICENSE
FL371289303Medicaid