Provider Demographics
NPI:1942227384
Name:DEL CORO AMENGUAL, CARLOS R (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:R
Last Name:DEL CORO AMENGUAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13330
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913-3330
Mailing Address - Country:US
Mailing Address - Phone:915-533-1789
Mailing Address - Fax:915-533-7234
Practice Address - Street 1:5407 N MESA ST STE 101
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5468
Practice Address - Country:US
Practice Address - Phone:915-533-1789
Practice Address - Fax:915-533-7234
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15167208600000X
TXQ4936208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI 50202Medicare UPIN
PR0023925Medicare ID - Type Unspecified