| Doctor Name: | DR. CARLOS A GOGLAS |
| NPI Number: | 1053590265 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 15672 |
| Business Practice Address: | 11200 Calle Margarita Hacienda Concordia Santa Isabel, PR - 007573122 |
| Business Phone Number: | 7878450128 |
| Business Fax Number: | |
| Mailing Address: | 11200 Calle Margarita, Hacienda Concordia SANTA ISABEL |
| State: | PR |
| Postal Code: | 007573122 |
| Phone Number: | 7878450128 |
| Fax Number: | |
| NPI Enumeration Date: | 10/24/2007 |
| NPI Last Update Date: | 10/24/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 15672 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |