Healthcare Provider Details

I. General information

NPI: 1740102474
Provider Name (Legal Business Name): OMAYRA MULERO CARRILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL MENONITA GUAYAMA AVE PEDRO ALBIZU CAMPO URB LA HACIENDA
GUAYAMA PR
00785
US

IV. Provider business mailing address

HOSPITAL MENONITA GUAYAMA AVE PEDRO ALBIZU CAMPO URB LA HACIENDA
GUAYAMA PR
00785
US

V. Phone/Fax

Practice location:
  • Phone: 787-864-4300
  • Fax:
Mailing address:
  • Phone: 787-864-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25156
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: