Provider Demographics
NPI:1003343187
Name:CARRASQUILLO, NAYDA IVETTE
Entity Type:Individual
Prefix:MS
First Name:NAYDA
Middle Name:IVETTE
Last Name:CARRASQUILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 13173
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-9621
Mailing Address - Country:US
Mailing Address - Phone:787-409-8391
Mailing Address - Fax:787-860-6464
Practice Address - Street 1:HC 3 BOX 13173
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-9621
Practice Address - Country:US
Practice Address - Phone:787-863-1880
Practice Address - Fax:787-860-6464
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist