Provider Demographics
NPI:1346292042
Name:MAESTRE-FERNANDEZ, CARLOS C (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:C
Last Name:MAESTRE-FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11484 CAPARRA HEIGHTS STATION
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-1484
Mailing Address - Country:US
Mailing Address - Phone:787-782-6030
Mailing Address - Fax:787-782-1565
Practice Address - Street 1:#6 U3 CARR 21
Practice Address - Street 2:LAS LOMAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-793-6867
Practice Address - Fax:787-782-1565
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3276174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC-78046Medicare UPIN
PR9-3573Medicare ID - Type Unspecified