Basic Information
| Provider Information | |||||||||
| NPI: | 1023139896 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLO | ||||||||
| FirstName: | SIMON | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 911 | ||||||||
| Address2: | |||||||||
| City: | CABO ROJO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006230911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876353680 | ||||||||
| FaxNumber: | 7877288316 | ||||||||
| Practice Location | |||||||||
| Address1: | 252 SAN JORGE ST. | ||||||||
| Address2: | SUITE 408 | ||||||||
| City: | SANTURCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877288316 | ||||||||
| FaxNumber: | 7877288316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207SG0203X | 12584 | PR | Y | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Molecular Genetics |
No ID Information.