Provider Demographics
NPI:1720099484
Name:CARRASQUILLO DOMINGUEZ, LUZ M (MD)
Entity Type:Individual
Prefix:DR
First Name:LUZ
Middle Name:M
Last Name:CARRASQUILLO DOMINGUEZ
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 9261
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:787-644-5890
Mailing Address - Fax:787-644-5890
Practice Address - Street 1:AVE JOSE GAUTIER BENITEZ CARR #1
Practice Address - Street 2:VILLA CARMEN 2ND SECC B-4
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-644-5890
Practice Address - Fax:787-644-5890
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11428208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0090048Medicare ID - Type Unspecified