Provider Demographics
NPI:1720620511
Name:CARVAJAL, MARIA FERNANDA (AP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:FERNANDA
Last Name:CARVAJAL
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13712 MOONSTONE CANYON DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-3504
Mailing Address - Country:US
Mailing Address - Phone:813-399-6011
Mailing Address - Fax:
Practice Address - Street 1:917 S PARSONS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6008
Practice Address - Country:US
Practice Address - Phone:813-341-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-13
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4067171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist