1356454052 NPI number — JORGE LUIS CARLO FONT M. D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356454052 NPI number — JORGE LUIS CARLO FONT M. D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CARLO FONT

Provider First Name:

JORGE

Provider Middle Name:

LUIS

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M. D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1356454052

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/26/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 1496

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MAYAGUEZ

Provider Business Mailing Address State Name:

PR

Provider Business Mailing Address Postal Code:

00681-1496

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

787-265-6392

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

EDIF LA PALMA

Provider Second Line Business Practice Location Address:

SUITE 2A

Provider Business Practice Location Address City Name:

MAYAGUEZ

Provider Business Practice Location Address State Name:

PR

Provider Business Practice Location Address Postal Code:

00680-4861

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

787-833-0348

Provider Business Practice Location Address Fax Number:

787-805-0710

Provider Enumeration Date:

08/16/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207V00000X , with the licence number:  6840 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 209342 . This is a "PREFERRED HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 601497 . This is a "MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 701997 . This is a "SSBELLAVISTA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 1035 . This is a "PMC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 6800041 . This is a "HUMANA INSURANCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: PE4721 . This is a "PALIC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 068506 . This is a "LA CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 2459 . This is a "AMERICAN HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 28131CA . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 37-06840 . This is a "UIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 28131 . This is a "S. S. S. OPTIMO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".