Provider Demographics
NPI:1730340993
Name:CARRASQUILLO, MAYRA
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:CARRASQUILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE PONCE DE LEON # 715
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3380
Mailing Address - Country:US
Mailing Address - Phone:787-758-2000
Mailing Address - Fax:787-771-7884
Practice Address - Street 1:AVE PONCE DE LEON # 715
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-3380
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:787-771-7884
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5934183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician