1306860960 NPI number — MRS. LILLIAM MARIA DOMINGUEZ PHARMACY TECHNICIAN

Table of content: MRS. LILLIAM MARIA DOMINGUEZ PHARMACY TECHNICIAN (NPI 1306860960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306860960 NPI number — MRS. LILLIAM MARIA DOMINGUEZ PHARMACY TECHNICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOMINGUEZ
Provider First Name:
LILLIAM
Provider Middle Name:
MARIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMACY TECHNICIAN
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:
1306860960
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
939 CALLE SAMARIA
Provider Second Line Business Mailing Address:
URB VILLA DEL CARMEN
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00716-2129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-873-1480
Provider Business Mailing Address Fax Number:
787-873-1480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 CALLE MARGINAL
Provider Second Line Business Practice Location Address:
SUITE 2 BO MAGINA
Provider Business Practice Location Address City Name:
SABANA GRANDE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00637-3004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-873-1480
Provider Business Practice Location Address Fax Number:
787-873-1480
Provider Enumeration Date:
07/27/2006

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:  2866 , 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)





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