Provider Demographics
NPI:1770325011
Name:CARBO ONTIVEROS, ELIUD
Entity type:Individual
Prefix:
First Name:ELIUD
Middle Name:
Last Name:CARBO ONTIVEROS
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 1:7123 FAITH WAY # 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3267
Mailing Address - Country:US
Mailing Address - Phone:512-660-2992
Mailing Address - Fax:
Practice Address - Street 1:7123 FAITH WAY # 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3267
Practice Address - Country:US
Practice Address - Phone:512-669-2992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program