Healthcare Provider Details

I. General information

NPI: 1013304179
Provider Name (Legal Business Name): SEBASTIAN CARRASQUILLO MONTALVO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-4392
US

IV. Provider business mailing address

3901 UNIVERSITY BLVD S STE 221
JACKSONVILLE FL
32216-4392
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-9079
  • Fax: 352-273-8889
Mailing address:
  • Phone: 904-244-3066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME154070
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME154070
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: