Healthcare Provider Details

I. General information

NPI: 1073691994
Provider Name (Legal Business Name): MADELINE SANTOS-CARLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #2 KM 119 SUITE 102 MEDICAL OPHTHALMIC PLAZA
BAYAMON PR
00959
US

IV. Provider business mailing address

QUINTA DEL RIO K6 PLAZA 20
BAYAMON PR
00961
US

V. Phone/Fax

Practice location:
  • Phone: 787-786-3340
  • Fax: 787-786-3331
Mailing address:
  • Phone: 787-786-3340
  • Fax: 787-786-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number9661
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: