Provider Demographics
NPI:1720130842
Name:CARRASQUILLO, GUILLERMO ENRIQUE II (DPM)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:ENRIQUE
Last Name:CARRASQUILLO
Suffix:II
Gender:M
Credentials:DPM
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 429
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0429
Mailing Address - Country:US
Mailing Address - Phone:787-843-7770
Mailing Address - Fax:
Practice Address - Street 1:1326 CALLE SALUD
Practice Address - Street 2:OF 303
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1686
Practice Address - Country:US
Practice Address - Phone:787-843-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00000048213ES0131X
WI000645213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR600570OtherMMM HEALTH
PR600570OtherMMM HEALTH
PRU64017Medicare UPIN