Healthcare Provider Details

I. General information

NPI: 1003807389
Provider Name (Legal Business Name): MARIA I CARRERA BAQUERO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CALLE UNION E
FAJARDO PR
00738-4801
US

IV. Provider business mailing address

PO BOX 667
FAJARDO PR
00738-0667
US

V. Phone/Fax

Practice location:
  • Phone: 787-863-1065
  • Fax: 787-863-1065
Mailing address:
  • Phone: 787-863-1065
  • Fax: 787-863-1065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number8515
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: