Provider Demographics
NPI:1710374806
Name:ROSARIO-ILLANAS, CARLA MARGARITA (MD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:MARGARITA
Last Name:ROSARIO-ILLANAS
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:PO BOX 79709
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-9709
Mailing Address - Country:US
Mailing Address - Phone:787-726-7438
Mailing Address - Fax:787-726-2827
Practice Address - Street 1:3018 AVE ISLA VERDE
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-4844
Practice Address - Country:US
Practice Address - Phone:787-726-7438
Practice Address - Fax:787-726-2827
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19786207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology