MEDICARE: JEAN PIERRE CARRASQUILLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	18865	PR

General Provider Information

NPI Number	:	1467695239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN PIERRE CARRASQUILLO

Provider Business Mailing Address
First Line	:	6400 AVE ISLA VERDE
Second Line	:	APT. 4C WEST
City	:	CAROLINA
State	:	PR
Zip	:	00979-7161
Country	:	US
Telephone Number	:	787-314-2325
Fax Number	:

Provider Business Practice Location Address
First Line	:	349 AVE HOSTOS
Second Line	:	MEDICAL EMPORIUM II SUITE A-29
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680-1509
Country	:	US
Telephone Number	:	787-690-2157
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2009
Last Update Date	:	10/01/2014

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Directions to “ JEAN PIERRE CARRASQUILLO ” Practice Location

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