1710414651 NPI number — ALTAGRACIA DEL CARMEN DE LA CRUZ TECNICO DE FARMACIA

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 1710414651 NPI number — ALTAGRACIA DEL CARMEN DE LA CRUZ TECNICO DE FARMACIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE LA CRUZ
Provider First Name:
ALTAGRACIA
Provider Middle Name:
DEL CARMEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
TECNICO 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:
1710414651
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
419 AVE PONCE DE LEON ESQ CALLE JUAN DUARTE
Provider Second Line Business Mailing Address:
METROPOLIS APTS APT 710
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-989-4416
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 AVE BARBOSA ESQ CALLE SICILIA
Provider Second Line Business Practice Location Address:
CDT DR KOPPISCH
Provider Business Practice Location Address City Name:
RIO PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-294-0076
Provider Business Practice Location Address Fax Number:
787-294-0076
Provider Enumeration Date:
05/22/2017

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:  011533 , 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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