Provider Demographics
NPI:1366448755
Name:GROVAS, CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:GROVAS
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 192279
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-2279
Mailing Address - Country:US
Mailing Address - Phone:787-754-8642
Mailing Address - Fax:787-766-0974
Practice Address - Street 1:COND MIDTOWN
Practice Address - Street 2:STE B12
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3416
Practice Address - Country:US
Practice Address - Phone:787-754-8642
Practice Address - Fax:787-766-0974
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3259174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0094204Medicare ID - Type Unspecified
PRD08641Medicare UPIN