Provider Demographics
NPI:1922002559
Name:NASSAR, CARLOS JOSE (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:JOSE
Last Name:NASSAR
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 9132
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-9132
Mailing Address - Country:US
Mailing Address - Phone:787-852-0920
Mailing Address - Fax:787-852-6685
Practice Address - Street 1:63 CRUZ ORTIZ STELLA AVE.
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-0920
Practice Address - Fax:787-852-6685
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR126722085B0100X, 2085U0001X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20111Medicare ID - Type Unspecified
PRG92654Medicare UPIN