Basic Information
| Provider Information | |||||||||
| NPI: | 1295800654 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRIETO DEJESUS | ||||||||
| FirstName: | CARMELITA | ||||||||
| MiddleName: | GUINTO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 BROWN SPRINGS RD | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361177005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342734159 | ||||||||
| FaxNumber: | 3342734556 | ||||||||
| Practice Location | |||||||||
| Address1: | 470 TAYLOR RD STE 310 | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361177130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342444322 | ||||||||
| FaxNumber: | 3342444321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 01/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 21912 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | H18394 | 01 | AL | VIVA HEALTH | OTHER | P01919334 | 01 | AL | RAILROAD MEDICARE | OTHER | 511-94769 | 01 | AL | BCBS OF AL | OTHER | 10211I3113 | 01 | AL | MEDICARE | OTHER | 203211 | 05 | AL | MEDICAID |