Organization
CAROLINE C HONCULADA M D LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAROLINE C HONCULADA M D (OWNER)
(863) 679-9494
Entity
Organization
Contact information
Practice address
425 S 11TH ST, SUITE 1, LAKE WALES, FL 33853-4342
(863) 679-9494
(863) 679-8866
Mailing address
425 S 11TH ST, SUITE 1, LAKE WALES, FL 33853-4239
(863) 679-9494
(863) 679-8866
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
ME0073068
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
255077600
—
FL
01
—
43859
BCBS
FL
Enumeration date
12/09/2008
Last updated
06/20/2012
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