Provider Demographics
NPI:1841250941
Name:POU, CARLOS ROBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ROBERTO
Last Name:POU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8508
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-0508
Mailing Address - Country:US
Mailing Address - Phone:787-781-4700
Mailing Address - Fax:787-781-1590
Practice Address - Street 1:100 CARR 165
Practice Address - Street 2:STE 310 CENTRO INT. DE MERCADEO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-781-4700
Practice Address - Fax:787-781-1590
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12463174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG15817Medicare UPIN