Provider Demographics
NPI:1255548004
Name:CARRASQUILLO- DAVILA, ALEIDA Y (MD)
Entity type:Individual
Prefix:DR
First Name:ALEIDA
Middle Name:Y
Last Name:CARRASQUILLO- DAVILA
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 521
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-0521
Mailing Address - Country:US
Mailing Address - Phone:787-367-6692
Mailing Address - Fax:
Practice Address - Street 1:137 CALLE 6
Practice Address - Street 2:BO. TORRECILLA ALTA
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-2209
Practice Address - Country:US
Practice Address - Phone:787-367-6692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13700208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2-0726Medicare ID - Type Unspecified