Provider Demographics
NPI:1760872337
Name:CARRERA GONZALEZ, ELISSA (MD)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:
Last Name:CARRERA GONZALEZ
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 1:1 CALLE 11 APT 701
Mailing Address - Street 2:COND PANORAMA PLAZA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3273
Mailing Address - Country:US
Mailing Address - Phone:787-607-0995
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL GENERAL MENONITA DE CAGUAS
Practice Address - Street 2:URB. TURABO GARDEN CARRETERA ESTATAL PR 172
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726-6660
Practice Address - Country:US
Practice Address - Phone:787-653-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR31574R207R00000X
PR32,712R390200000X
PR21411207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program