Provider Demographics
NPI:1427640812
Name:CARVAJAL, EDUARDO (MD)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:CARVAJAL
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 1:609 ESCONDIDO CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-3215
Mailing Address - Country:US
Mailing Address - Phone:407-409-3275
Mailing Address - Fax:
Practice Address - Street 1:609 ESCONDIDO CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-3215
Practice Address - Country:US
Practice Address - Phone:407-409-3275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ07101208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice