Individual provider Active NPI

Carla Antola Lardizabal, MD

  • Family Medicine Physician
  • Weston, FL
National Provider Identifier
1568654101
Registry record updated Sep 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME126706 Issued in FL
Practice address
2300 N Commerce Parkway
Weston, FL 33326
Phone
(954) 217-5700
NPI assigned
Aug 17, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A124251 CA
Family Medicine Physician 207Q00000X MD150544 OR
Family Medicine Physician 207Q00000X 4301090806 MI
Family Medicine Physician 207Q00000X ME126706 FL Primary

Addresses

Primary practice location

2300 N Commerce Parkway
Weston, FL 33326

Mailing address

1608 SE 3Rd Ave
Third Floor Pbo
Fort Lauderdale, FL 33316-2564

Other identifiers 5

IdentifierTypeStateIssuer
ME126706OtherFLMEDICAL LICENSE
161133OtherORNBMC GROUP MEDICAID
4301090806OtherMISTATE LICENCE
R0000WFBTVOtherORNBMC GROUP MEDICARE
MD150544OtherOROREGON MEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140509000629 CA Practitioner - Family Practice 1456485572 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A124251CAMDFamily Medicine Physician
ME126706FLMDFamily Medicine Physician
4301090806MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers of San Diego, Inc Current Accepting new patients
Family Health Centers of San Diego, Inc Current Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Dec 25, 2013 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Dec 25, 2013 Accepting new patients

Locations

1111 W Chase Ave
El Cajon, CA 92020
Phone (619) 515-2499

1809 National Ave
San Diego, CA 92113
Phone (619) 515-2500

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536192000000",
    "number": "1568654101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1608 SE 3RD AVE",
            "address_2": "THIRD FLOOR PBO",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 N COMMERCE PARKWAY",
            "city": "WESTON",
            "state": "FL",
            "postal_code": "33326",
            "telephone_number": "954-217-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTOLA LARDIZABAL",
        "first_name": "CARLA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-17",
        "last_updated": "2018-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A124251",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD150544",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301090806",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME126706",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ME126706",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NBMC GROUP MEDICAID",
            "identifier": "161133",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENCE",
            "identifier": "4301090806",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NBMC GROUP MEDICARE",
            "identifier": "R0000WFBTV",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON MEDICAL LICENSE",
            "identifier": "MD150544",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Weston, FL

Sources for this page

Verify at the official NPI Registry.