Provider Demographics
NPI:1053590265
Name:GOGLAS, CARLOS A
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:GOGLAS
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 1:11200 CALLE MARGARITA
Mailing Address - Street 2:HACIENDA CONCORDIA
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-3122
Mailing Address - Country:US
Mailing Address - Phone:787-845-0128
Mailing Address - Fax:
Practice Address - Street 1:11200 CALLE MARGARITA
Practice Address - Street 2:HACIENDA CONCORDIA
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-3122
Practice Address - Country:US
Practice Address - Phone:787-845-0128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15672261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care