Provider Demographics
NPI:1366636482
Name:CARRASQUILLO, GLADYSIRIS (MT)
Entity Type:Individual
Prefix:MRS
First Name:GLADYSIRIS
Middle Name:
Last Name:CARRASQUILLO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CALLE CATALINA MORALES
Mailing Address - Street 2:SUITE 2
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-3305
Mailing Address - Country:US
Mailing Address - Phone:787-266-3300
Mailing Address - Fax:787-266-3500
Practice Address - Street 1:125 MANSIONES DEL CARIBE AC-11
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-5206
Practice Address - Country:US
Practice Address - Phone:787-453-5989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6204246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist