Provider Demographics
NPI:1669411336
Name:SANTOS GONZALEZ, CARMEN I (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:I
Last Name:SANTOS GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:269 AVE PINERO
Mailing Address - Street 2:HYDE PARK
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-3901
Mailing Address - Country:US
Mailing Address - Phone:787-765-9470
Mailing Address - Fax:787-751-2762
Practice Address - Street 1:269 AVE PINERO
Practice Address - Street 2:HYDE PARK
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-3901
Practice Address - Country:US
Practice Address - Phone:787-765-9470
Practice Address - Fax:787-751-2762
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7413207W00000X, 207WX0108X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory Disease
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD-32350Medicare UPIN
PR2-9646Medicare ID - Type UnspecifiedPROVIDER NUMBER