Provider Demographics
NPI:1972835999
Name:CARRILLO, CELESTE AIDA (MD)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:AIDA
Last Name:CARRILLO
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:P.O. BOX 714
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0714
Mailing Address - Country:US
Mailing Address - Phone:787-344-2902
Mailing Address - Fax:787-831-4677
Practice Address - Street 1:CARR. 349 KM 2.7 CERRO LAS MESAS
Practice Address - Street 2:HOSPITAL BELLA VISTA
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681
Practice Address - Country:US
Practice Address - Phone:787-834-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR171742208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice