Provider Demographics
NPI:1760883854
Name:CARLOS ALCALA
Entity Type:Organization
Organization Name:CARLOS ALCALA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR IN MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:ALCALA MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-250-1193
Mailing Address - Street 1:239 AVE. ARTERIAL HOSTOS
Mailing Address - Street 2:CAPITAL CENTER SUR, STE 606
Mailing Address - City:SAN JUAN
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00918
Mailing Address - Country:UM
Mailing Address - Phone:787-250-1193
Mailing Address - Fax:787-281-6119
Practice Address - Street 1:239 AVE ARTERIAL HOSTOS
Practice Address - Street 2:CAPITAL CENTER SUR, STE 606
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1474
Practice Address - Country:US
Practice Address - Phone:787-250-1193
Practice Address - Fax:787-281-6119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR008089207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0029483OtherPTAN
PRE04609Medicare UPIN