Provider Demographics
NPI:1821009366
Name:ROSADO CARRILLO, LUIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:ROSADO CARRILLO
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:PO BOX 965
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-0965
Mailing Address - Country:US
Mailing Address - Phone:787-720-6376
Mailing Address - Fax:787-790-1570
Practice Address - Street 1:11 CALLE CARAZO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5644
Practice Address - Country:US
Practice Address - Phone:787-720-6376
Practice Address - Fax:787-790-1570
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12896207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR12896OtherMEDICAL LICENSE
PR12896OtherMEDICAL LICENSE
PRH70731Medicare UPIN