Provider Demographics
NPI:1427101534
Name:CABEZAROMERO, CARMEN (MD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:CABEZAROMERO
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 1:9425 FONTAINEBLEAU BLVD
Mailing Address - Street 2:101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-7509
Mailing Address - Country:US
Mailing Address - Phone:305-940-2239
Mailing Address - Fax:305-485-2481
Practice Address - Street 1:9425 FONTAINEBLEAU BLVD
Practice Address - Street 2:101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-7509
Practice Address - Country:US
Practice Address - Phone:305-940-2239
Practice Address - Fax:305-485-2481
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL61220207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF66867Medicare UPIN
FL23383AMedicare ID - Type Unspecified