Provider Demographics
NPI:1700868031
Name:CARRILLO-CARAMBOT, RAFAEL J (MD)
Entity Type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:J
Last Name:CARRILLO-CARAMBOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10 CALLE UNION W
Mailing Address - Street 2:FAJARDO MEDICAL PLAZA SUITE 204
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-4706
Mailing Address - Country:US
Mailing Address - Phone:787-863-3450
Mailing Address - Fax:787-860-5203
Practice Address - Street 1:10 CALLE UN E
Practice Address - Street 2:FAJARDO MEDICAL PLAZA SUITE 204
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4817
Practice Address - Country:US
Practice Address - Phone:787-863-3450
Practice Address - Fax:787-860-5203
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR8734208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D34206Medicare UPIN
PR0029824Medicare ID - Type Unspecified