Provider Demographics
NPI:1659468478
Name:GONZALEZ-CARRASQUILLO, ANGEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:A
Last Name:GONZALEZ-CARRASQUILLO
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 1:9 VALLE ESCONDIDO ESTATES
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971-8000
Mailing Address - Country:US
Mailing Address - Phone:787-731-1290
Mailing Address - Fax:
Practice Address - Street 1:9 VALLE ESCONDIDO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00971-8000
Practice Address - Country:US
Practice Address - Phone:787-731-1290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5402207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC79570Medicare UPIN