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General NPI Number Information
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NPI Number | 1326648379
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Entity Type | Organization
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Legal Business Name | CARRILLO CARDIOVASCULAR MEDICINE LLC
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | AVE FONT MARTELLO 856 HOSPITAL RYDER SUITE 105
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City | HUMACAO
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State | PR
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Zip | 00791
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Country | US
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Telephone | 787-920-4090
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Fax | 877-736-2593
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Provider Business Mailing Address
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Address Line | URB. QUINTAS DE SAN LUIS CALLE CAMPECHE A6
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-372-2044
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUAN ERNESTO CARRILLO NAVAS
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Credential | MD
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Telephone | 787-372-2044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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