Healthcare Provider Details

I. General information

NPI: 1710023668
Provider Name (Legal Business Name): JOSE RAFAEL CARLO-IZQUIERDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PPMI-RCM AVE. AMERICO MIRANDA APTDO. 19134 CENTRO MEDICO DE PR EDIF PRINCIPAL ESCUELA DE MEDICINA
SAN JUAN PR
00929
US

IV. Provider business mailing address

URB. SAN FRANCISCO 1712 LILAS ST.
SAN JUAN PR
00927
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2525
  • Fax: 787-754-0474
Mailing address:
  • Phone: 787-764-4474
  • Fax: 787-754-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number7092
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number7092
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: