Healthcare Provider Details

I. General information

NPI: 1861233579
Provider Name (Legal Business Name): MAXIMILIANO CARRERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. PORTA COELI, 2 A9
SAN GERMAN PR
00683
US

IV. Provider business mailing address

URB. PORTA COELI, 2 A9
SAN GERMAN PR
00683
US

V. Phone/Fax

Practice location:
  • Phone: 787-632-4347
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37794
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: