Provider Demographics
NPI:1609810258
Name:CARRASQUILLO, MARITZA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARITZA
Middle Name:
Last Name:CARRASQUILLO
Suffix:
Gender:F
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:URB.MAGNOLIA GARDENS
Mailing Address - Street 2:CALLE 10 G-5
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-2602
Mailing Address - Country:US
Mailing Address - Phone:787-778-5960
Mailing Address - Fax:
Practice Address - Street 1:CALLE CASIA
Practice Address - Street 2:#10 VA MEDICAL CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3201
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:787-641-8369
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14250207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine