Provider Demographics
NPI:1386940831
Name:ZAMORA PARRA, CARLOS A
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:A
Last Name:ZAMORA PARRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 SW 87TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2462
Mailing Address - Country:US
Mailing Address - Phone:786-241-4740
Mailing Address - Fax:
Practice Address - Street 1:790 NW 107TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-3100
Practice Address - Country:US
Practice Address - Phone:305-964-5426
Practice Address - Fax:305-964-5627
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS.0100036171M00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016415000Medicaid