1720185655 NPI number — FARMACIA EL DIVINO NINO LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720185655 NPI number — FARMACIA EL DIVINO NINO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARMACIA EL DIVINO NINO LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1720185655
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
835 CALLE CONCEPCION VERA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOCA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00676-5016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-818-4839
Provider Business Mailing Address Fax Number:
787-877-8129

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 110 KM 10.5
Provider Second Line Business Practice Location Address:
835 CONCEPCION VERA
Provider Business Practice Location Address City Name:
MOCA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-818-4839
Provider Business Practice Location Address Fax Number:
787-877-8129
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
XOCHITL
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST/OWNER
Authorized Official Telephone Number:
787-818-4839

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 17-F-2289 , 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: 2087087 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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