MEDICARE: DR. CARLOS R DEL CORO AMENGUAL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	15167	PR
2	208600000X	Surgery Physician	Q4936	TX

General Provider Information

NPI Number	:	1942227384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS R DEL CORO AMENGUAL MD

Provider Business Mailing Address
First Line	:	PO BOX 13330
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79913-3330
Country	:	US
Telephone Number	:	915-533-1789
Fax Number	:	915-533-7234

Provider Business Practice Location Address
First Line	:	5407 N MESA ST STE 101
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-5468
Country	:	US
Telephone Number	:	915-533-1789
Fax Number	:	915-533-7234

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	07/05/2023

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