Provider Demographics
NPI:1447600168
Name:HERNANDEZ CARRASQUILLO, ATALIA
Entity Type:Individual
Prefix:
First Name:ATALIA
Middle Name:
Last Name:HERNANDEZ CARRASQUILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CARR 31
Mailing Address - Street 2:BO CEIBA NORTE
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-3896
Mailing Address - Country:US
Mailing Address - Phone:787-679-6569
Mailing Address - Fax:
Practice Address - Street 1:22 CARR 31
Practice Address - Street 2:BO CEIBA NORTE
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3896
Practice Address - Country:US
Practice Address - Phone:787-679-6569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1087224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant