Provider Demographics
NPI:1457627481
Name:VERDEZA, CARLOS
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:VERDEZA
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 1:13780 SW 26TH ST
Mailing Address - Street 2:205
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6302
Mailing Address - Country:US
Mailing Address - Phone:786-332-2172
Mailing Address - Fax:786-332-4694
Practice Address - Street 1:13780 SW 26TH ST
Practice Address - Street 2:205
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6302
Practice Address - Country:US
Practice Address - Phone:786-332-2172
Practice Address - Fax:786-332-4694
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100864363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant