Healthcare Provider Details

I. General information

NPI: 1316694755
Provider Name (Legal Business Name): CARLOS F VIERA MALDONADO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2022
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AVE LAUREL
BAYAMON PR
00956-4816
US

IV. Provider business mailing address

PO BOX 464
BARRANQUITAS PR
00794
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-5151
  • Fax:
Mailing address:
  • Phone: 939-225-0564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: