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General NPI Number Information
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NPI Number | 1548350564
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Entity Type | Individual
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Provider Name | SIMON ENRIQUE CARLO M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 01/30/2008
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Provider Practice Location Address
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Address Line | VALLE HERMOSO SHOPPING CENTER LOC. #8
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City | HORMIGUEROS
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State | PR
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Zip | 00660
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Country | US
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Telephone | 787-834-9469
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Fax | 787-834-9469
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Provider Business Mailing Address
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Address Line | 64 CALLE MALAGA SULTANA
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City | MAYAGUEZ
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State | PR
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Zip | 00680-1433
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Country | US
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Telephone | 787-833-7347
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Fax | 787-834-9469
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 5205
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License Number State | PR
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