Provider Demographics
NPI:1821147448
Name:CARLO, ANANSKA M (MD)
Entity Type:Individual
Prefix:
First Name:ANANSKA
Middle Name:M
Last Name:CARLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 CALLE MALAGA
Mailing Address - Street 2:URB SULTANA
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-1433
Mailing Address - Country:US
Mailing Address - Phone:787-849-4868
Mailing Address - Fax:
Practice Address - Street 1:8 AVE LUIS MUNOZ MARIN
Practice Address - Street 2:
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660-1722
Practice Address - Country:US
Practice Address - Phone:787-849-4868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14331208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
H80169Medicare UPIN
21331Medicare ID - Type Unspecified