Provider Demographics
NPI:1871651448
Name:CARRILLO, RAFAEL ORLANDO SR (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ORLANDO
Last Name:CARRILLO
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 360903
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-0903
Mailing Address - Country:US
Mailing Address - Phone:787-319-7826
Mailing Address - Fax:
Practice Address - Street 1:AVE. PONCE DE LEON 715
Practice Address - Street 2:CLINICAS EXTERNAS HOSP. AUXILIO MUTUO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-319-7826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3773208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C83927Medicare UPIN