Healthcare Provider Details

I. General information

NPI: 1104070150
Provider Name (Legal Business Name): LOURDES M BALSEIRO PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VILLA RICA AJ-16 SONIA ST
BAYAMON PR
00959-4918
US

IV. Provider business mailing address

285 CALLE LILIA BARROSO CIUDAD JARDIN III
TOA ALTA PR
00953-4882
US

V. Phone/Fax

Practice location:
  • Phone: 787-786-9100
  • Fax:
Mailing address:
  • Phone: 787-279-0712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3172
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: