Provider Demographics
NPI:1851434435
Name:CARRETERO, CARLOS R (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:R
Last Name:CARRETERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 781165
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78278-1165
Mailing Address - Country:US
Mailing Address - Phone:210-224-4811
Mailing Address - Fax:210-224-1573
Practice Address - Street 1:414 NAVARRO ST
Practice Address - Street 2:STE 703
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2515
Practice Address - Country:US
Practice Address - Phone:210-224-4811
Practice Address - Fax:210-224-1573
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP7616207R00000X
PR14599207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1780241737OtherGROUP NPI
PR1851434435OtherNPI: 1851434435