Provider Demographics
NPI:1700193521
Name:CARRASQUILLO, ALEXANDER
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:CARRASQUILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:MS
Other - First Name:MARICARMEN
Other - Middle Name:
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ASIST TO
Mailing Address - Street 1:PO BOX 10027
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-1027
Mailing Address - Country:US
Mailing Address - Phone:787-929-9736
Mailing Address - Fax:
Practice Address - Street 1:CALLE 28 T 17
Practice Address - Street 2:VILLA UNIVERSITARIA
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-929-9736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR657251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health