Provider Demographics
NPI:1982745436
Name:CARRASQUILLO, EFRAIN (MD)
Entity type:Individual
Prefix:DR
First Name:EFRAIN
Middle Name:
Last Name:CARRASQUILLO
Suffix:
Gender:M
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 667
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-0667
Mailing Address - Country:US
Mailing Address - Phone:787-884-8686
Mailing Address - Fax:866-444-8389
Practice Address - Street 1:TORRE MEDICA 1 CARR #2
Practice Address - Street 2:DOCTORS' CENTER HOSPITAL SUITE 211
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-8686
Practice Address - Fax:866-444-8389
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13110207RR0500X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82116Medicare UPIN
PR20240Medicare ID - Type Unspecified