Healthcare Provider Details

I. General information

NPI: 1306813530
Provider Name (Legal Business Name): FRANCISCO JOSE CARLOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 PONCE DE LEON AVE SUITE 801
SAN JUAN PR
00917-5022
US

IV. Provider business mailing address

735 PONCE DE LEON AVE SUITE 801
SAN JUAN PR
00917-5022
US

V. Phone/Fax

Practice location:
  • Phone: 787-771-1000
  • Fax: 787-771-1001
Mailing address:
  • Phone: 787-771-1000
  • Fax: 787-771-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number7979
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: