Provider Demographics
NPI:1649473943
Name:CARLOS C ANTONETTI
Entity type:Organization
Organization Name:CARLOS C ANTONETTI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANTONETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-691-4144
Mailing Address - Street 1:515 W LITTLE YORK RD
Mailing Address - Street 2:STE C
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77091-2496
Mailing Address - Country:US
Mailing Address - Phone:713-691-4144
Mailing Address - Fax:713-694-6021
Practice Address - Street 1:515 W LITTLE YORK RD
Practice Address - Street 2:STE C
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-2496
Practice Address - Country:US
Practice Address - Phone:713-691-4144
Practice Address - Fax:713-694-6021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD3707207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00C730Medicare ID - Type Unspecified
TXB20920Medicare UPIN