Basic Information
| Provider Information | |||||||||
| NPI: | 1063737856 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARRASQUILLO | ||||||||
| FirstName: | FAUSTO | ||||||||
| MiddleName: | ROBERTO | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1580 SANTA BARBARA BLVD | ||||||||
| Address2: | |||||||||
| City: | THE VILLAGES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321596827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522592159 | ||||||||
| FaxNumber: | 3522595731 | ||||||||
| Practice Location | |||||||||
| Address1: | 1580 SANTA BARBARA BLVD | ||||||||
| Address2: | |||||||||
| City: | THE VILLAGES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321596827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522592159 | ||||||||
| FaxNumber: | 3522595731 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2010 | ||||||||
| LastUpdateDate: | 01/26/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA 9105255 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.