=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134478605
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARRASQUERO PEDIATRICS AND ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2012
-----------------------------------------------------
Last Update Date | 08/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 407 WEKIVA SPRINGS ROAD SUITE 110
-----------------------------------------------------
City | LONGWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-790-7998
-----------------------------------------------------
Fax | 407-951-8821
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 407 WEKIVA SPRINGS ROAD SUITE 110
-----------------------------------------------------
City | LONGWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-790-7998
-----------------------------------------------------
Fax | 407-951-8821
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | DR. LUISA CARRASQUERO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 407-790-7998
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME99334
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------