Provider Demographics
NPI:1881661056
Name:PENTZKE-CHAMORRO, CARLOS M (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:M
Last Name:PENTZKE-CHAMORRO
Suffix:
Gender:M
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:PO BOX 6980
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-6980
Mailing Address - Country:US
Mailing Address - Phone:787-780-0991
Mailing Address - Fax:787-785-0844
Practice Address - Street 1:1 CALLE HERMINIO MIRANDA
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-3032
Practice Address - Country:US
Practice Address - Phone:787-862-4321
Practice Address - Fax:787-369-7656
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15834208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0023073Medicare ID - Type Unspecified