Provider Demographics
NPI:1871937037
Name:CARRASQUILLO CARDIOLOGY, PSC
Entity type:Organization
Organization Name:CARRASQUILLO CARDIOLOGY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:CARRASQUILLO-NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-367-0787
Mailing Address - Street 1:PO BOX 1311
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-1311
Mailing Address - Country:US
Mailing Address - Phone:787-367-0787
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY #1 BO. MONTE LLANO KM 55.2
Practice Address - Street 2:PLAZA CAYEY CARIBBEAN CINEMAS BUILDING SUITE #202
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-367-0787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17470207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRGD295AMedicare PIN