Provider Demographics
NPI:1366254989
Name:COBA SAN LUCAS, CARLOS SEBASTIAN
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:SEBASTIAN
Last Name:COBA SAN LUCAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 NW 114TH CT APT 105
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-3846
Mailing Address - Country:US
Mailing Address - Phone:786-586-9216
Mailing Address - Fax:
Practice Address - Street 1:5701 NW 114TH CT APT 105
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-3846
Practice Address - Country:US
Practice Address - Phone:786-586-9216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter