Provider Demographics
NPI:1871695247
Name:NEGRON-OLMO, CARLOS R (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:R
Last Name:NEGRON-OLMO
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:AX-5 HERMOSILLO URB. VENUS GARDENS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4696
Mailing Address - Country:US
Mailing Address - Phone:787-755-1733
Mailing Address - Fax:
Practice Address - Street 1:CARR. 164 SECTOR EL DESVIO
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719
Practice Address - Country:US
Practice Address - Phone:787-869-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14307208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH98114Medicare UPIN
PR2-0952Medicare ID - Type Unspecified