Provider Demographics
NPI:1891899084
Name:CIGARROA, CARLOS G (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:G
Last Name:CIGARROA
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 451428
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0035
Mailing Address - Country:US
Mailing Address - Phone:956-728-8255
Mailing Address - Fax:956-728-0400
Practice Address - Street 1:702 E CALTON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3988
Practice Address - Country:US
Practice Address - Phone:956-728-8255
Practice Address - Fax:956-728-0400
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1212207R00000X, 246W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0039HXOtherBLUE CROSS BLUE SHIELD
TX133675208Medicaid
TX0039HXOtherBLUE CROSS BLUE SHIELD
TX00129FMedicare PIN