1871695247 NPI number — DR. CARLOS R. NEGRON-OLMO MD

Table of content: DR. CARLOS R. NEGRON-OLMO MD (NPI 1871695247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871695247 NPI number — DR. CARLOS R. NEGRON-OLMO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEGRON-OLMO
Provider First Name:
CARLOS
Provider Middle Name:
R.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1871695247
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AX-5 HERMOSILLO URB. VENUS GARDENS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-4696
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-755-1733
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 164 SECTOR EL DESVIO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NARANJITO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-869-1290
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  14307 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)