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Individual

MARY CARTER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3801 NW 174TH ST, MIAMI GARDENS, FL 33055-3825
(305) 628-8957
Mailing address
3801 NW 174TH ST, MIAMI GARDENS, FL 33055-3825
(305) 628-8957

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
FRC 0108-2277-97
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
230215200
MEDICAID PROVIDER NUMBER
FL
Enumeration date
05/20/2008
Last updated
05/20/2008
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