Healthcare Provider Details

I. General information

NPI: 1831902097
Provider Name (Legal Business Name): SUSANNE LEUKER ORTIZ VALENTIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 AVE SAN JOSE
AIBONITO PR
00705
US

IV. Provider business mailing address

HC 1 BOX 5629
AIBONITO PR
00705-9725
US

V. Phone/Fax

Practice location:
  • Phone: 787-991-7355
  • Fax:
Mailing address:
  • Phone: 787-671-7255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number8385
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: