Individual
CAROL M ANTEQUERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
1475 NW 12TH AVE, MIAMI, FL 33136-1002
(305) 243-8644
Mailing address
1611 NW 12TH AVE, PO BOX 016960 (M851), MIAMI, FL 33136-1005
(305) 243-7688
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 9105769
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA 9105769
PHYSICIAN ASSISTANT
FL
Enumeration date
03/07/2011
Last updated
03/16/2012
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