Healthcare Provider Details

I. General information

NPI: 1790454460
Provider Name (Legal Business Name): KAROLYN NICOLE CARLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5357 CALLE BAGAZO
PONCE PR
00728-2436
US

IV. Provider business mailing address

5357 CALLE BAGAZO
PONCE PR
00728-2436
US

V. Phone/Fax

Practice location:
  • Phone: 787-217-2300
  • Fax:
Mailing address:
  • Phone: 787-217-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: