Provider Demographics
NPI:1205922275
Name:CARRASQUILLO, OLVEEN (MD)
Entity type:Individual
Prefix:DR
First Name:OLVEEN
Middle Name:
Last Name:CARRASQUILLO
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 1:1120 NW 14TH ST
Mailing Address - Street 2:SUITE 1532
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2107
Mailing Address - Country:US
Mailing Address - Phone:305-585-5368
Mailing Address - Fax:305-585-5355
Practice Address - Street 1:1120 NW 14TH ST
Practice Address - Street 2:SUITE 1532
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2107
Practice Address - Country:US
Practice Address - Phone:305-585-5368
Practice Address - Fax:305-585-5355
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193458207R00000X
FLME104030207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF79881Medicare UPIN