Provider Demographics
NPI:1841295755
Name:CARLO, ANIBAL (MD)
Entity type:Individual
Prefix:DR
First Name:ANIBAL
Middle Name:
Last Name:CARLO
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 366879
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6879
Mailing Address - Country:US
Mailing Address - Phone:787-763-4106
Mailing Address - Fax:787-763-4074
Practice Address - Street 1:LA TORRE DE PLAZA, SUITE 605
Practice Address - Street 2:PLAZA LAS AMERICAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-763-4106
Practice Address - Fax:787-763-4074
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9152208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81666Medicare ID - Type Unspecified
PRE30434Medicare UPIN