Healthcare Provider Details

I. General information

NPI: 1356549828
Provider Name (Legal Business Name): MRS. LUZ C BIDOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STREET J #9 DOCTORS CENTER HOSPITAL
BAYAMON PR
00960
US

IV. Provider business mailing address

VILLAS SAN AGUSTIN 8 STREET #N25
BAYAMON PR
00959-2055
US

V. Phone/Fax

Practice location:
  • Phone: 787-622-5420
  • Fax:
Mailing address:
  • Phone: 787-740-7798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1903
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: