Provider Demographics
NPI:1649204223
Name:RIVERA CARRASQUILLO, JOSE M (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:M
Last Name:RIVERA CARRASQUILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:M
Other - Last Name:RIVERA CARRASQUILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3190
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-3190
Mailing Address - Country:US
Mailing Address - Phone:787-544-0472
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 455 KM 2.0 BO QUEBRADA
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-544-0472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15206208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice