Healthcare Provider Details

I. General information

NPI: 1386731362
Provider Name (Legal Business Name): CARLOS ALBERTO GOMEZ-MARCIAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1462 PROFESOR AUGUSTO RODRIGUEZ
SANTURCE PR
00910-2137
US

IV. Provider business mailing address

100 GRAND BOULEVARD PASEO SUITE 112-190
SAN JUAN PR
00926-5955
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-1616
  • Fax:
Mailing address:
  • Phone: 787-397-0263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number6196
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: