Provider Demographics
NPI:1326648379
Name:CARRILLO CARDIOVASCULAR MEDICINE LLC
Entity Type:Organization
Organization Name:CARRILLO CARDIOVASCULAR MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:ERNESTO
Authorized Official - Last Name:CARRILLO NAVAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-372-2044
Mailing Address - Street 1:URB. QUINTAS DE SAN LUIS
Mailing Address - Street 2:CALLE CAMPECHE A6
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-372-2044
Mailing Address - Fax:
Practice Address - Street 1:AVE FONT MARTELLO 856
Practice Address - Street 2:HOSPITAL RYDER SUITE 105
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-920-4090
Practice Address - Fax:877-736-2593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty