Provider Demographics
NPI:1669445128
Name:CARRASQUILLO, LUIS
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
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:CALLE 220 4Q42 COLINAS DE FAIR VIEW
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-760-0574
Mailing Address - Fax:787-760-0574
Practice Address - Street 1:89 CAROLINA CT
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-3500
Practice Address - Country:US
Practice Address - Phone:787-757-0548
Practice Address - Fax:787-760-0574
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1130122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist