Provider Demographics
NPI:1255060380
Name:POVENTUD ESCORIAZA, CARLOS A
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:POVENTUD ESCORIAZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAN ANTON, CALLE ERNESTO RODRIGUEZ
Mailing Address - Street 2:K9
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-550-7559
Mailing Address - Fax:
Practice Address - Street 1:PASEO DR. JOSE CELSO BARBOSA
Practice Address - Street 2:UPR - MEDICAL SCIENCES CAMPUS, SCHOOL OF PHARMACY
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-5067
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program