Provider Demographics
NPI:1134478605
Name:CARRASQUERO PEDIATRICS AND ASSOCIATES
Entity Type:Organization
Organization Name:CARRASQUERO PEDIATRICS AND ASSOCIATES
Other - Org Name:WEKIVA SPRINGS PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:LUISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRASQUERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-790-7998
Mailing Address - Street 1:407 WEKIVA SPRINGS ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779
Mailing Address - Country:US
Mailing Address - Phone:407-790-7998
Mailing Address - Fax:407-951-8821
Practice Address - Street 1:407 WEKIVA SPRINGS ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779
Practice Address - Country:US
Practice Address - Phone:407-790-7998
Practice Address - Fax:407-951-8821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99334174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279635000Medicaid