Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 163791 | NY |
N | 208600000X | Surgeon | 163791 | NY |
N | 208200000X | Surgeon | 52509 | WI |
N | 208600000X | Surgeon | 52509 | WI |
N | 208200000X | Surgeon | Q8031 | TX |
N | 208600000X | Surgeon | Q8031 | TX |
N | 2082S0105X | Plastic Hand Surgeon | 163791 | NY |
N | 2082S0105X | Plastic Hand Surgeon | 52509 | WI |
Y | 2086S0122X | Plastic and Reconstructive Surgery | Q8031 | TX |
NPI | 1851319321 |
---|---|
Provider Name | Dr. Ines M Carrasquillo |
First Address | Malvern, PA 19355-0746 |
Second Address | Mcallen, TX 78503-2932 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 26/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3654790-01 | (05) | TX |
8GK212 | BCBS OF TEXAS (01) | TX |