Healthcare Provider Details

I. General information

NPI: 1346570207
Provider Name (Legal Business Name): POLICLINICA DR. LUIS RODRIGUEZ CARRASQUILLO, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2009
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAMPO RICO ST . A6 CASTELLANA GARDENS
CAROLINA PR
00983
US

IV. Provider business mailing address

PO BOX 3762
CAROLINA PUERTO RICO
00984
UM

V. Phone/Fax

Practice location:
  • Phone: 787-752-7897
  • Fax: 787-768-0689
Mailing address:
  • Phone: 787-752-7897
  • Fax: 787-768-0689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StatePR

VIII. Authorized Official

Name: LIZ OROZCO RIOS
Title or Position: MEDICAL BILLER
Credential:
Phone: 787-752-7897