Provider Demographics
NPI:1295800654
Name:PRIETO DEJESUS, CARMELITA GUINTO (MD)
Entity type:Individual
Prefix:DR
First Name:CARMELITA
Middle Name:GUINTO
Last Name:PRIETO DEJESUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BROWN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7005
Mailing Address - Country:US
Mailing Address - Phone:334-747-4159
Mailing Address - Fax:
Practice Address - Street 1:470 TAYLOR RD STE 310
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7130
Practice Address - Country:US
Practice Address - Phone:334-747-4322
Practice Address - Fax:334-747-4321
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21912207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL203211Medicaid
AL10211I3113OtherMEDICARE
AL511-94769OtherBCBS OF AL
ALP01919334OtherRAILROAD MEDICARE
ALH18394OtherVIVA HEALTH