Provider Demographics
NPI:1427795749
Name:CARRASCO TENEZACA, FELIPE JACINTO (MD)
Entity type:Individual
Prefix:
First Name:FELIPE
Middle Name:JACINTO
Last Name:CARRASCO TENEZACA
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 1:20 YORK STREET
Mailing Address - Street 2:UNHH TOMPKINS 226
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-688-9503
Mailing Address - Fax:203-688-5599
Practice Address - Street 1:20 YORK STREET
Practice Address - Street 2:UNHH TOMPKINS 226
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-9503
Practice Address - Fax:203-688-5599
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program