Healthcare Provider Details

I. General information

NPI: 1942260450
Provider Name (Legal Business Name): VICTOR JOSE CARLO-CHEVERE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 CALLE LOIZA SUITE 206
SAN JUAN PR
00911-1801
US

IV. Provider business mailing address

1760 CALLE LOIZA SUITE 206
SAN JUAN PR
00911-1801
US

V. Phone/Fax

Practice location:
  • Phone: 787-602-3768
  • Fax: 787-728-6031
Mailing address:
  • Phone: 787-602-3768
  • Fax: 787-728-6031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number13216
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number13216
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: