Healthcare Provider Details

I. General information

NPI: 1487206314
Provider Name (Legal Business Name): MILENIA URBINA SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

D32 MARGINAL EXT FOREST HILLS
BAYAMON PR
00951
US

IV. Provider business mailing address

D32 MARGINAL EXT FOREST HILLS
BAYAMON PR
00951
US

V. Phone/Fax

Practice location:
  • Phone: 787-620-9602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number7237
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: