Healthcare Provider Details

I. General information

NPI: 1912293473
Provider Name (Legal Business Name): MRS. NEIDA NAVEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BOULEVARD DR
BAYAMON PR
00959-6624
US

IV. Provider business mailing address

100 BOULEVARD DR
BAYAMON PR
00959-6624
US

V. Phone/Fax

Practice location:
  • Phone: 787-394-2353
  • Fax:
Mailing address:
  • Phone: 787-397-2353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3032
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: