Provider Demographics
NPI:1124122452
Name:ORRACA, CARLOS G (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:G
Last Name:ORRACA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-884-0623
Mailing Address - Fax:
Practice Address - Street 1:CARR #2 MARGINAL ELLIOT VELEZ B-45
Practice Address - Street 2:URB ATENAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-0623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR100120OtherMMM
PR4137OtherINTERNATIONAL MEDICAL CAR
PR1110284OtherACAA
PR069686OtherCRUZ AZUL
PR1110284OtherACAA
PR4137OtherINTERNATIONAL MEDICAL CAR