Healthcare Provider Details

I. General information

NPI: 1134023559
Provider Name (Legal Business Name): CARLOS R CARRASQUILLO PACHECO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 NW 66TH ST APT 408
DORAL FL
33178-5507
US

IV. Provider business mailing address

10700 NW 66TH ST APT 408
DORAL FL
33178-5507
US

V. Phone/Fax

Practice location:
  • Phone: 786-306-9733
  • Fax:
Mailing address:
  • Phone: 786-306-9733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number26200
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: