Provider Demographics
NPI:1710025739
Name:GOLDEROS, CARMEN G (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:G
Last Name:GOLDEROS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:19.22 AVE RAMIREZ DE ARELLANO
Mailing Address - Street 2:PMB 147
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-3175
Mailing Address - Country:US
Mailing Address - Phone:787-870-4069
Mailing Address - Fax:787-870-4725
Practice Address - Street 1:12-B RIO DEL PLATA MALL
Practice Address - Street 2:URB. JARDINES DE TOA ALTA
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-870-4069
Practice Address - Fax:787-870-4725
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR5700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics