Provider Demographics
NPI:1437254026
Name:BACO-ALFARO, CARLOS (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:BACO-ALFARO
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 7004
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7004
Mailing Address - Country:US
Mailing Address - Phone:787-840-2575
Mailing Address - Fax:787-840-8391
Practice Address - Street 1:AVE. HOSPITAL # 15
Practice Address - Street 2:
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720
Practice Address - Country:US
Practice Address - Phone:787-840-2575
Practice Address - Fax:787-840-8391
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR124412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry