Healthcare Provider Details

I. General information

NPI: 1114148467
Provider Name (Legal Business Name): YOLANDA I. KUILAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CALLE DR VEVE
BAYAMON PR
00961-6105
US

IV. Provider business mailing address

PO BOX 589
TOA BAJA PR
00951-0589
US

V. Phone/Fax

Practice location:
  • Phone: 787-785-0277
  • Fax:
Mailing address:
  • Phone: 787-261-0713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0792
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: