Organization
BLUE DIAMOND MEDICAL CENTER CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCOS JOSE CARVAJAL APRN (APRN-FNP)
(305) 456-0148
Entity
Organization
Contact information
Practice address
16430 NW 59TH AVE, MIAMI LAKES, FL 33014-5605
(305) 456-0148
Mailing address
16430 NW 59TH AVE STE 202, MIAMI LAKES, FL 33014-5605
(305) 456-0148
(305) 456-7559
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
08/05/2022
Last updated
04/15/2023
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