Provider Demographics
NPI:1699596957
Name:CARRERAS, FERNANDO LUIS
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:LUIS
Last Name:CARRERAS
Suffix:
Gender:M
Credentials:
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 1528
Mailing Address - Street 2:
Mailing Address - City:JAYUYA
Mailing Address - State:PR
Mailing Address - Zip Code:00664-2528
Mailing Address - Country:US
Mailing Address - Phone:787-382-2062
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1528
Practice Address - Street 2:
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664-2528
Practice Address - Country:US
Practice Address - Phone:787-382-2062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2761390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program