Provider Demographics
NPI:1134573611
Name:PADILLA-CARRASQUILLO, LAURA P (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:P
Last Name:PADILLA-CARRASQUILLO
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:PO BOX 1040
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1040
Mailing Address - Country:US
Mailing Address - Phone:787-918-0066
Mailing Address - Fax:504-503-4341
Practice Address - Street 1:MANATI MEDICAL CENTER
Practice Address - Street 2:668 CALLE HERNANDEZ CARRION SUITE 203
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-1040
Practice Address - Country:US
Practice Address - Phone:787-918-0066
Practice Address - Fax:787-918-0064
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA313335208M00000X
390200000X
PR019759207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty