Healthcare Provider Details

I. General information

NPI: 1104965664
Provider Name (Legal Business Name): MARIA E. CARRASCAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 RB BAHIA ST. URB. MARINA BAHIA
CATANO PR
00962
US

IV. Provider business mailing address

BAHIA ST. RB -38 URB. MARINA BAHIA
CATANO PR
00962
US

V. Phone/Fax

Practice location:
  • Phone: 787-275-3087
  • Fax: 787-275-3087
Mailing address:
  • Phone: 787-275-3087
  • Fax: 787-275-3087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number11970
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: