| Doctor Name: | DR. CARLOS ENRIQUE FOSSI |
| NPI Number: | 1982627774 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M,D. |
| License Number: | ME51410 |
| Business Practice Address: | 5030 Kingswood Dr Lakeland, FL - 338133026 |
| Business Phone Number: | 8632740853 |
| Business Fax Number: | 8635829436 |
| Mailing Address: | 5030 Kingswood Dr, LAKELAND |
| State: | FL |
| Postal Code: | 338133026 |
| Phone Number: | 8632740853 |
| Fax Number: | 8635829436 |
| NPI Enumeration Date: | 07/25/2006 |
| NPI Last Update Date: | 01/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 310400000X |
| License Number: | ME51410 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Assisted Living Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |