1558732198 NPI number — MRS. YASHIRA MARIE PEREZ AGOSTO AUXILIAR DE FARMACIA

Table of content: MRS. YASHIRA MARIE PEREZ AGOSTO AUXILIAR DE FARMACIA (NPI 1558732198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558732198 NPI number — MRS. YASHIRA MARIE PEREZ AGOSTO AUXILIAR DE FARMACIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREZ AGOSTO
Provider First Name:
YASHIRA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
AUXILIAR DE FARMACIA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558732198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1607
Provider Second Line Business Mailing Address:
BO. LIRIOS RAMAL 929 K1 H4
Provider Business Mailing Address City Name:
JUNCOS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00777-1607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-412-8507
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 931 KM2.0
Provider Second Line Business Practice Location Address:
BO. NAVARRO
Provider Business Practice Location Address City Name:
GURABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00778-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-687-2584
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/08/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183700000X , with the licence number:  10933 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10933 . This is a "TECNICO DE FARMACIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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