Healthcare Provider Details

I. General information

NPI: 1427182773
Provider Name (Legal Business Name): JORGE D. CARRERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JORGE DAMIAN CARRERA M.D.

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6TH STREET, K-58 URB. PRADO ALTO
GUAYNABO PR
00966
US

IV. Provider business mailing address

6TH STREET, K-58 URB. PRADO ALTO
GUAYNABO PR
00966
US

V. Phone/Fax

Practice location:
  • Phone: 787-834-4770
  • Fax: 787-265-2120
Mailing address:
  • Phone: 787-834-4770
  • Fax: 787-265-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number7777
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number7777
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: