Provider Demographics
NPI:1487659462
Name:CHIESA, CARLOS JUAN (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:JUAN
Last Name:CHIESA
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:URB. BUCARE
Mailing Address - Street 2:#29 AMATISTA ST.
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-720-8113
Mailing Address - Fax:
Practice Address - Street 1:#66 SANTA CRUZ ST.
Practice Address - Street 2:INSTITUTO SAN PABLO - SUITE 409
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-787-5045
Practice Address - Fax:787-798-1690
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5761207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9-7286OtherTRIPLE S
PR65711OtherCRUZ AZUL
PR65711OtherCRUZ AZUL