MEDICARE: MS. MARIA CARRILLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	000287	PR

General Provider Information

NPI Number	:	1649490947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA CARRILLO

Provider Business Mailing Address
First Line	:	CALLE 19 S.E. # 1011
Second Line	:	REPARTO METROPOLITANO
City	:	SAN JUAN
State	:	PR
Zip	:	00921
Country	:	US
Telephone Number	:	787-309-7089
Fax Number	:

Provider Business Practice Location Address
First Line	:	HOSPITAL PEDIATRICO UNIVERSITARIO
Second Line	:	CALL BOX 191079
City	:	SAN JUAN
State	:	PR
Zip	:	00919-1079
Country	:	US
Telephone Number	:	787-777-3535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2007
Last Update Date	:	07/08/2007

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