Provider Demographics
NPI:1851751408
Name:CARRASQUILLO NAVARRO, MARYTERE (MD)
Entity Type:Individual
Prefix:
First Name:MARYTERE
Middle Name:
Last Name:CARRASQUILLO NAVARRO
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 1:680 COHASSET RD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2213
Mailing Address - Country:US
Mailing Address - Phone:530-342-4395
Mailing Address - Fax:530-894-2325
Practice Address - Street 1:680 COHASSET RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2213
Practice Address - Country:US
Practice Address - Phone:530-342-4395
Practice Address - Fax:530-894-2325
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA162664207RI0200X, 207R00000X
PR31916R208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice