Provider Demographics
NPI:1497814297
Name:GARRASTEGUI, JUAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:J
Last Name:GARRASTEGUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 CALLE REINA ISABEL
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-3008
Mailing Address - Country:US
Mailing Address - Phone:787-399-6448
Mailing Address - Fax:
Practice Address - Street 1:1012 CALLE REINA ISABEL
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3008
Practice Address - Country:US
Practice Address - Phone:787-399-6448
Practice Address - Fax:787-851-3558
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 71214207R00000X
TXL1586207R00000X, 208M00000X
NY191192207R00000X
PR10222207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0761967 01Medicaid
TX0761967 01Medicaid
TX0761967 01Medicaid
PR0082386Medicare ID - Type UnspecifiedPROVIDER #