1518633502 NPI number — GABRIELA ALANIS CARRASQUILLO MERCADO M.S.

Table of content: GABRIELA ALANIS CARRASQUILLO MERCADO M.S. (NPI 1518633502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518633502 NPI number — GABRIELA ALANIS CARRASQUILLO MERCADO M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARRASQUILLO MERCADO
Provider First Name:
GABRIELA
Provider Middle Name:
ALANIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

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:
1518633502
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1051 CALLE 3 SE APT 109
Provider Second Line Business Mailing Address:
CONDOMINIO MEDICAL PLAZA
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00921-3007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-617-0470
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE ENCARNACION 1576
Provider Second Line Business Practice Location Address:
URB CAPARRA HEIGHTS
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-708-4997
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  004259 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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