Individual
COLBERTH D CARRASQUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
TARGET CASE MANAGER
Contact information
Practice address
5449 S SEMORA BLVD #3, SUITE 20, ORLANDO, FL 32823
(787) 645-7302
Mailing address
5449 S SEMORA BLVD #3, SUITE 20, ORLANDO, FL 32822
(787) 645-7302
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C624-104-87-137-0
ID DRIVEN LICENSE
FL
Enumeration date
06/29/2021
Last updated
06/29/2021
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