1164596771 NPI number — CARLOS REMEDIOS-CARBONE M.D.

Table of content: CARLOS REMEDIOS-CARBONE M.D. (NPI 1164596771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164596771 NPI number — CARLOS REMEDIOS-CARBONE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REMEDIOS-CARBONE
Provider First Name:
CARLOS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1164596771
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PMB 140 APARTADO 2000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERCEDITA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-813-4401
Provider Business Mailing Address Fax Number:
787-813-4403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDIF PARRAS # 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00717-1321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-813-4401
Provider Business Practice Location Address Fax Number:
787-813-4403
Provider Enumeration Date:
11/17/2006

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: 2085R0001X , with the licence number:  10236 , 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)

  • Identifier: 3600009 . This is a "ID PROVIDER HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 600705 . This is a "ID PROVIDER MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2483 . This is a "ID PROVIDER PREFERRED" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 4160-5 . This is a "ID PROVIDER PROSAM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 82550 . This is a "ID PROVIDER TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 069447 . This is a "ID PROVIDER CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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