Provider Demographics
NPI:1447027792
Name:BARRAMEDA PEREZ, CARLOS RAUL (PA)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:RAUL
Last Name:BARRAMEDA PEREZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 VINETREE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2086
Mailing Address - Country:US
Mailing Address - Phone:813-312-8727
Mailing Address - Fax:
Practice Address - Street 1:1114 VINETREE DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-2086
Practice Address - Country:US
Practice Address - Phone:813-312-8727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1959363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant