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General NPI Number Information
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NPI Number | 1366636482
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Entity Type | Individual
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Provider Name | GLADYSIRIS CARRASQUILLO MT
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Gender | Female
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Dates
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Enumeration Date | 08/31/2007
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Last Update Date | 08/31/2007
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Provider Practice Location Address
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Address Line | 125 MANSIONES DEL CARIBE AC-11
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City | HUMACAO
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State | PR
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Zip | 00791-5206
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Country | US
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Telephone | 787-453-5989
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Fax |
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Provider Business Mailing Address
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Address Line | 5 CALLE CATALINA MORALES SUITE 2
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City | YABUCOA
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State | PR
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Zip | 00767-3305
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Country | US
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Telephone | 787-266-3300
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Fax | 787-266-3500
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246QM0706X
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Taxonomy Name | Medical Technologist
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License Number | 6204
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License Number State | PR
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