MEDICARE: JANICE 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	174400000X	Specialist	MA53421	FL

General Provider Information

NPI Number	:	1942456298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE CARRASQUILLO

Provider Business Mailing Address
First Line	:	810 N ROSE AVE
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-4944
Country	:	US
Telephone Number	:	407-343-6111
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 N ROSE AVE
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-4944
Country	:	US
Telephone Number	:	407-343-6111
Fax Number	:

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

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	08/18/2008

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Directions to “ JANICE CARRASQUILLO ” Practice Location

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