MEDICARE: DOMINIQUE FRANCHESKA ESPAILLAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	5588	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5588	OTHER	PR	PHARMACIST TECHNICHIAN

General Provider Information

NPI Number	:	1871838508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE FRANCHESKA ESPAILLAT

Provider Business Mailing Address
First Line	:	URB.BRISAS DE ANASCO CALLER 10
Second Line	:	CASA GG 8
City	:	ANASCO
State	:	PR
Zip	:	00610
Country	:	US
Telephone Number	:	787-996-6770
Fax Number	:

Provider Business Practice Location Address
First Line	:	METRO OFFICE PARK # 6
Second Line	:	CALLE 1 SUITE 101
City	:	GUAYNABO
State	:	PR
Zip	:	00968-1704
Country	:	US
Telephone Number	:	787-522-5252
Fax Number	:	787-522-5253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2012
Last Update Date	:	12/06/2012

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