Provider Demographics
NPI:1710023668
Name:CARLO-IZQUIERDO, JOSE RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RAFAEL
Last Name:CARLO-IZQUIERDO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:URB. SAN FRANCISCO 1712 LILAS ST.
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:787-764-4474
Mailing Address - Fax:787-754-0474
Practice Address - Street 1:PPMI-RCM AVE. AMERICO MIRANDA APTDO. 19134
Practice Address - Street 2:CENTRO MEDICO DE PR EDIF PRINCIPAL ESCUELA DE MEDICINA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00929
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:787-754-0474
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR70922084N0400X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Not Answered2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7092OtherSTATE LICENSE
PR98634Medicare ID - Type UnspecifiedPROVIDER NUMBER