Provider Demographics
NPI:1427287838
Name:FELIX TACORONTE, CARMEN LUISA (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:LUISA
Last Name:FELIX TACORONTE
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1110 N EL DORADO PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4606
Mailing Address - Country:US
Mailing Address - Phone:520-327-5677
Mailing Address - Fax:
Practice Address - Street 1:1110 N EL DORADO PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4606
Practice Address - Country:US
Practice Address - Phone:520-327-5677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ46475207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ710400Medicaid