Healthcare Provider Details

I. General information

NPI: 1962346718
Provider Name (Legal Business Name): CARMEN FREYTES POLANCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA DEL MERCADO LOCAL 39
MANATI PR
00674
US

IV. Provider business mailing address

URB LAS PRADERAS 1219 L13 CALLE AQUAMARINA
BARCELONETA PR
00617-2836
US

V. Phone/Fax

Practice location:
  • Phone: 676-637-1173
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: