Healthcare Provider Details

I. General information

NPI: 1699531996
Provider Name (Legal Business Name): JEAN-LUC CHARLOT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 AVE GENERAL VALERO
FAJARDO PR
00738-3998
US

IV. Provider business mailing address

7880 SW 183RD TER
PALMETTO BAY FL
33157-6231
US

V. Phone/Fax

Practice location:
  • Phone: 787-655-0505
  • Fax:
Mailing address:
  • Phone: 401-300-8859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number023599
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: