1326648379 NPI number — CARRILLO CARDIOVASCULAR MEDICINE LLC

Table of content: (NPI 1326648379)

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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