Healthcare Provider Details

I. General information

NPI: 1982983193
Provider Name (Legal Business Name): CARLOS A AVELLANET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13-25 CALLE 8 SANTA ROSA
BAYAMON PR
00959-6627
US

IV. Provider business mailing address

CALLE 8 BLOQUE 13 # 25 SANTA ROSA
BAYAMON PR
00959
US

V. Phone/Fax

Practice location:
  • Phone: 201-294-5847
  • Fax: 201-243-6914
Mailing address:
  • Phone: 201-294-5847
  • Fax: 201-243-6914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number7174
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: