Provider Demographics
NPI:1689627028
Name:ANAYA, CARLOS ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALBERTO
Last Name:ANAYA
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:J22 CALLE J
Mailing Address - Street 2:VILLACAPARRA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2203
Mailing Address - Country:US
Mailing Address - Phone:310-926-8512
Mailing Address - Fax:
Practice Address - Street 1:CALLE F VEGAS JIMENEZ
Practice Address - Street 2:MANATI MEDICAL CENTER RADIOLOGY DEPARTMENT
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-621-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA902682085R0202X
PR0207372085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A902680OtherMEDICAL
CAI34985Medicare UPIN
CA00A902680OtherMEDICAL
CAWA90268AMedicare ID - Type Unspecified