Provider Demographics
NPI:1730165655
Name:CARTAYA, ALFREDO BERNARD (MD)
Entity type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:BERNARD
Last Name:CARTAYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EZEQUIEL
Other - Middle Name:BERNARD
Other - Last Name:CARTAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11161 STATE ROAD 70 E STE 110-135
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-9407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11375 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5409
Practice Address - Country:US
Practice Address - Phone:888-258-3326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54848208000000X, 2080N0001X
TXN20232080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062456000Medicaid
C57693Medicare UPIN