Healthcare Provider Details

I. General information

NPI: 1124452602
Provider Name (Legal Business Name): YURIELYS VAZQUEZ COTTO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE ORQUIDEA # 5 REPARTO VALENCIA
BAYAMON PR
00956
US

IV. Provider business mailing address

HC 5 BOX 6690
AGUAS BUENAS PR
00703-9083
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-4360
  • Fax:
Mailing address:
  • Phone: 787-732-2247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number8296
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: