1326648379 NPI number — CARRILLO CARDIOVASCULAR MEDICINE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326648379 NPI number — CARRILLO CARDIOVASCULAR MEDICINE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARRILLO CARDIOVASCULAR MEDICINE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326648379
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB. QUINTAS DE SAN LUIS
Provider Second Line Business Mailing Address:
CALLE CAMPECHE A6
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-372-2044
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE FONT MARTELLO 856
Provider Second Line Business Practice Location Address:
HOSPITAL RYDER SUITE 105
Provider Business Practice Location Address City Name:
HUMACAO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-920-4090
Provider Business Practice Location Address Fax Number:
877-736-2593
Provider Enumeration Date:
10/29/2020

Additional Information

Authorized Official

Authorized Official Last Name:
CARRILLO NAVAS
Authorized Official First Name:
JUAN
Authorized Official Middle Name:
ERNESTO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-372-2044

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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