Provider Demographics
NPI:1063969012
Name:TAMAYO, CARLA (MD)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:TAMAYO
Suffix:
Gender:F
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 1660
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1660
Mailing Address - Country:US
Mailing Address - Phone:787-918-7045
Mailing Address - Fax:
Practice Address - Street 1:2 CALLE MENDEZ VIGO W
Practice Address - Street 2:STE 3D
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4983
Practice Address - Country:US
Practice Address - Phone:787-834-2800
Practice Address - Fax:443-557-3178
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA156932207R00000X
PR21597207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine