Healthcare Provider Details

I. General information

NPI: 1053855171
Provider Name (Legal Business Name): YARIDA GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CALLE MUNOZ RIVERA
CABO ROJO PR
00623-4041
US

IV. Provider business mailing address

45 CALLE MUNOZ RIVERA
CABO ROJO PR
00623-4041
US

V. Phone/Fax

Practice location:
  • Phone: 787-851-1250
  • Fax: 787-851-1250
Mailing address:
  • Phone: 787-851-1250
  • Fax: 787-851-1250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number3797
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: