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General NPI Number Information
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NPI Number | 1639206253
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Entity Type | Individual
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Provider Name | CARLOS ANTONIO IZCOA D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | B9 CALLE SANTA CRUZ
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City | BAYAMON
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State | PR
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Zip | 00961-6902
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Country | US
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Telephone | 787-798-1772
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Fax | 787-288-5021
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Provider Business Mailing Address
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Address Line | D9 CALLE 1
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City | BAYAMON
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State | PR
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Zip | 00961-6908
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Country | US
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Telephone | 787-798-1772
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Fax |
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 2244
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License Number State | PR
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