Provider Demographics
NPI:1689728800
Name:GARCIA PRIETO, CARLOS EMILIO (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:EMILIO
Last Name:GARCIA PRIETO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 EMERGENCY LN STE 4
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5500
Mailing Address - Country:US
Mailing Address - Phone:863-382-7792
Mailing Address - Fax:863-304-8589
Practice Address - Street 1:3750 EMERGENCY LN STE 4
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5500
Practice Address - Country:US
Practice Address - Phone:863-382-7792
Practice Address - Fax:863-304-8589
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6995A2084P0800X
FL1111262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113075534Medicaid
FLFL008ZMedicare PIN