Healthcare Provider Details

I. General information

NPI: 1760574131
Provider Name (Legal Business Name): MICHELLE CARLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AVE CASA LINDA STE 101 ENTRADA AMERICAN MILITARY ACADEMY
BAYAMON PR
00959-8998
US

IV. Provider business mailing address

PMB 509 P.O.BOX 7891
GUAYNABO PR
00970-7891
US

V. Phone/Fax

Practice location:
  • Phone: 787-789-1919
  • Fax: 787-789-1921
Mailing address:
  • Phone: 787-789-1919
  • Fax: 787-789-1921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number15118
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: