Provider Demographics
NPI:1730536970
Name:CRESPO, CARMEN M (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:M
Last Name:CRESPO
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 1:300 CALLE POSEIDON
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784-6636
Mailing Address - Country:US
Mailing Address - Phone:787-464-1145
Mailing Address - Fax:
Practice Address - Street 1:36 CALLE NEVAREZ
Practice Address - Street 2:APART 6A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-4500
Practice Address - Country:US
Practice Address - Phone:787-464-1145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
PR19993208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No282N00000XHospitalsGeneral Acute Care Hospital