Provider Demographics
NPI:1386889210
Name:FEBLES MENA, CARLOS J
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:J
Last Name:FEBLES MENA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ESTRELLA DEL MAR M-10
Mailing Address - Street 2:DORADO DEL MAR
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-647-2910
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA #155 KM 31.5
Practice Address - Street 2:BO. GATO
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720
Practice Address - Country:US
Practice Address - Phone:787-867-3007
Practice Address - Fax:787-867-3007
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1048291U00000X
PR993291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031521Medicare PIN