Provider Demographics
NPI:1417916230
Name:PEREZ CARRASQUILLO, ERIC M (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:PEREZ CARRASQUILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PMB 236
Mailing Address - Street 2:200 AVE RAFAEL CORDERO SUITE 140
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-747-0790
Mailing Address - Fax:787-747-0790
Practice Address - Street 1:AVE JOSE VILLARES
Practice Address - Street 2:URB PARADISE CALLE 6 APTO 1A
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-747-0790
Practice Address - Fax:787-747-0790
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR12200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88864Medicare ID - Type Unspecified
PRG41793Medicare UPIN