Healthcare Provider Details

I. General information

NPI: 1922160241
Provider Name (Legal Business Name): MARIANA VICEORTA GONZALEZ FIGUEROA AUXILIAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VICTOR ROJAS #2 ZONA INDUSTRIAL CARR 129
ARECIBO PR
00612
US

IV. Provider business mailing address

URB PATEOS REALES CALLE LA REINA #776
ARECIBO PR
00612
US

V. Phone/Fax

Practice location:
  • Phone: 787-816-2156
  • Fax: 787-816-2156
Mailing address:
  • Phone: 787-390-7398
  • Fax: 787-816-2156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number4150
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: