Healthcare Provider Details

I. General information

NPI: 1225349426
Provider Name (Legal Business Name): CARLOS M MONGIL DVM, DIP. ACVS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CARR 873 # KM
SAN JUAN PR
00926-8600
US

IV. Provider business mailing address

BOSQUE DE LOS FRAILES 9 FRAY INIGO
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-708-4545
  • Fax:
Mailing address:
  • Phone: 787-708-4545
  • Fax: 787-708-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number204
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: