Provider Demographics
NPI:1023453594
Name:CARRASCO-AVINO, GONZALO (MD)
Entity type:Individual
Prefix:DR
First Name:GONZALO
Middle Name:
Last Name:CARRASCO-AVINO
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:ONE GUSTAVE L. PLACE, BOX 1194 (ANNEMBERG 15-32)
Mailing Address - Street 2:MOUNT SINAI SCHOOL OF MEDICINE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6574
Mailing Address - Country:US
Mailing Address - Phone:347-824-8241
Mailing Address - Fax:
Practice Address - Street 1:ONE GUSTAVE L. PLACE, MOUNT SINAI SCHOOL OF MEDICINE
Practice Address - Street 2:BOX 1194 (ANNEMBERG 15-32)
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6574
Practice Address - Country:US
Practice Address - Phone:347-824-8241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP86284390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY939503478OtherUNITED HEALTH CARE