Provider Demographics
NPI:1740597822
Name:FORS CARBONELL, JOSE MIGUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MIGUEL
Last Name:FORS CARBONELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:M
Other - Last Name:FORS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3000
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-3000
Mailing Address - Country:US
Mailing Address - Phone:787-383-4567
Mailing Address - Fax:
Practice Address - Street 1:COMMERCE PLAZA
Practice Address - Street 2:SUITE 301-305
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00785-3000
Practice Address - Country:US
Practice Address - Phone:787-383-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18009208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR18009OtherLICENCIA