Provider Demographics
NPI:1801918610
Name:POLO, CARLOS RAFAEL
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:RAFAEL
Last Name:POLO
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MILTON
Other - Middle Name:JOSE
Other - Last Name:MERCADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1371
Mailing Address - Street 2:
Mailing Address - City:SAINT JUST
Mailing Address - State:PR
Mailing Address - Zip Code:00978-1371
Mailing Address - Country:US
Mailing Address - Phone:787-473-2333
Mailing Address - Fax:787-721-1688
Practice Address - Street 1:5 G-10 RIBERAS DEL RIO DEV.
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-473-2333
Practice Address - Fax:787-721-1688
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies