Healthcare Provider Details

I. General information

NPI: 1730448788
Provider Name (Legal Business Name): MR. ROBERTO J. CARRIL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 AVE HOSTOS SUITE 7
MAYAGUEZ PR
00682-1522
US

IV. Provider business mailing address

PO BOX 339
SAN SEBASTIAN PR
00685-0339
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-0663
  • Fax: 787-831-3714
Mailing address:
  • Phone: 787-241-8443
  • Fax: 787-831-3714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number0152
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: