Healthcare Provider Details

I. General information

NPI: 1700575495
Provider Name (Legal Business Name): JAMIL ANTONIO ABOU EL HOSSEN CARMONA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO MEDICO DE PR Y EL CARIBE UPR-RECINTO CIENCIAS MEDICAS
RIO PIEDRAS PR
00921
US

IV. Provider business mailing address

PO BOX 2116
SAN JUAN PR
00922-2116
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-0101
  • Fax:
Mailing address:
  • Phone: 787-754-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24307
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: