Provider Demographics
NPI:1124203955
Name:MONTES-CARRILLO, BERNADETTE (MD-GENERAL PRACTICE)
Entity type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:
Last Name:MONTES-CARRILLO
Suffix:
Gender:F
Credentials:MD-GENERAL PRACTICE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 CALLE TROPICAL
Mailing Address - Street 2:URB. MONTEHIEDRA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-312-5554
Mailing Address - Fax:
Practice Address - Street 1:30 AVE TERESA JORNET SUITE 114
Practice Address - Street 2:GALERIA PACIFICO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-665-0450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16976208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice