Provider Demographics
NPI:1467695239
Name:CARRASQUILLO, JEAN PIERRE
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:PIERRE
Last Name:CARRASQUILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 AVE ISLA VERDE
Mailing Address - Street 2:APT. 4C WEST
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-7161
Mailing Address - Country:US
Mailing Address - Phone:787-314-2325
Mailing Address - Fax:
Practice Address - Street 1:349 AVE HOSTOS
Practice Address - Street 2:MEDICAL EMPORIUM II SUITE A-29
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1509
Practice Address - Country:US
Practice Address - Phone:787-690-2157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18865208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery