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General NPI Number Information
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NPI Number | 1043508914
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Entity Type | Organization
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Legal Business Name | CARBONELL MEDICAL CLINIC MD PA
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Dates
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Enumeration Date | 07/13/2011
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Last Update Date | 07/13/2011
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Provider Practice Location Address
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Address Line | 426 CASTROVILLE RD. STE. 3
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City | SAN ANTONIO
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State | TX
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Zip | 78207-5169
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Country | US
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Telephone | 210-433-6452
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Fax | 210-433-6452
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Provider Business Mailing Address
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Address Line | 426 CASTROVILLE RD. STE. 3
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City | SAN ANTONIO
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State | TX
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Zip | 78207-5169
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Country | US
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Telephone | 210-433-6452
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Fax | 210-433-6452
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CARLOS D. CARBONELL
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Credential | M.D.
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Telephone | 210-433-6452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D6974
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License Number State | TX
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