Provider Demographics
NPI:1043986953
Name:DRA. DIANNE CARRASQUILLO
Entity Type:Organization
Organization Name:DRA. DIANNE CARRASQUILLO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRASQUILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-405-1271
Mailing Address - Street 1:286 AVE DOMENECH
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3506
Mailing Address - Country:US
Mailing Address - Phone:787-314-4443
Mailing Address - Fax:
Practice Address - Street 1:142 CALLE DEL PARQUE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1965
Practice Address - Country:US
Practice Address - Phone:787-725-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty