Provider Demographics
NPI:1457347122
Name:NEGRON, CARMEN
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:
Last Name:NEGRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CALLE CALAZAN LASALLE
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-4178
Mailing Address - Country:US
Mailing Address - Phone:787-818-0485
Mailing Address - Fax:787-818-0485
Practice Address - Street 1:CARR 307 KM 2.5
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00622-0000
Practice Address - Country:US
Practice Address - Phone:787-818-0485
Practice Address - Fax:787-818-0485
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9702208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice