Basic Information
| Provider Information | |||||||||
| NPI: | 1184114738 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | METSAVAHT CARA | ||||||||
| FirstName: | VALENTINA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1611 NW 12 AVE JACKSON MEMORIAL HOSPITAL, | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053558264 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1611 NW 12 AVE JACKSON MEMORIAL HOSPITAL, | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053558264 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2018 | ||||||||
| LastUpdateDate: | 02/18/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 01/09/2019 | ||||||||
| NPIReactivationDate: | 02/18/2019 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.