Individual
DR. CARLA ANTOLA LARDIZABAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2300 N COMMERCE PARKWAY, WESTON, FL 33326
(954) 217-5700
Mailing address
1608 SE 3RD AVE, THIRD FLOOR PBO, FORT LAUDERDALE, FL 33316-2564
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301090806
MI
207Q00000X
Family Medicine Physician
A124251
CA
207Q00000X
Family Medicine Physician
MD150544
OR
207Q00000X
Family Medicine Physician
Primary
ME126706
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
161133
NBMC GROUP MEDICAID
OR
01
—
4301090806
STATE LICENCE
MI
01
—
MD150544
OREGON MEDICAL LICENSE
OR
01
—
ME126706
MEDICAL LICENSE
FL
01
—
R0000WFBTV
NBMC GROUP MEDICARE
OR
Enumeration date
08/17/2007
Last updated
09/06/2018
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