Provider Demographics
NPI:1699174011
Name:VECCHI, CAROLINA MARIA (LAC)
Entity type:Individual
Prefix:MRS
First Name:CAROLINA
Middle Name:MARIA
Last Name:VECCHI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MRS
Other - First Name:CAROLINA
Other - Middle Name:
Other - Last Name:VECCHI-MANGANARO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:304 INDIAN TRCE
Mailing Address - Street 2:#282
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2996
Mailing Address - Country:US
Mailing Address - Phone:713-679-0185
Mailing Address - Fax:
Practice Address - Street 1:304 INDIAN TRCE
Practice Address - Street 2:#282
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326
Practice Address - Country:US
Practice Address - Phone:713-679-0185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS207Q00000X
FL6084811171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty