Individual provider Active NPI

Mariceli Carrasquillo-Plaza, MD

  • General Practice Physician
  • Mayaguez, PR
National Provider Identifier
1679957641
Registry record updated Jul 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
19130 Issued in PR
Practice address
14 Calle de Diego E
Suit 102
Mayaguez, PR 00680-4890
Phone
(787) 834-8640
Fax
(787) 834-8640
NPI assigned
Jul 19, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 19, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 19130 PR Primary

Addresses

Primary practice location

14 Calle de Diego E
Suit 102
Mayaguez, PR 00680-4890

Mailing address

PO Box 2411
Mayaguez, PR 00681-2411
Phone (787) 806-7966

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151123000005 PR Practitioner - General Practice 0547560666 Practice locations: Mayaguez, PR

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Calle de Diego 14
Oficina 102
Mayaguez, PR 00680
Phone (787) 834-8640

Hospital & facility affiliations

  • Hospicio la Providencia Hospice, Ponce, PR, CCN 401500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
19130PRMDGeneral Practice Physician

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437264000000",
    "number": "1679957641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2411",
            "city": "MAYAGUEZ",
            "state": "PR",
            "postal_code": "006812411",
            "telephone_number": "787-806-7966",
            "fax_number": "787-834-8640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 CALLE DE DIEGO E",
            "address_2": "SUIT 102",
            "city": "MAYAGUEZ",
            "state": "PR",
            "postal_code": "006804890",
            "telephone_number": "787-834-8640",
            "fax_number": "787-834-8640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRASQUILLO-PLAZA",
        "first_name": "MARICELI",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-19",
        "last_updated": "2015-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "19130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mayaguez, PR

Sources for this page

Verify at the official NPI Registry.