Healthcare Provider Details

I. General information

NPI: 1326648379
Provider Name (Legal Business Name): CARRILLO CARDIOVASCULAR MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 10/29/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE FONT MARTELLO 856 HOSPITAL RYDER SUITE 105
HUMACAO PR
00791
US

IV. Provider business mailing address

URB. QUINTAS DE SAN LUIS CALLE CAMPECHE A6
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 787-920-4090
  • Fax: 877-736-2593
Mailing address:
  • Phone: 787-372-2044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JUAN ERNESTO CARRILLO NAVAS
Title or Position: PRESIDENT
Credential: MD
Phone: 787-372-2044