Healthcare Provider Details

I. General information

NPI: 1023542396
Provider Name (Legal Business Name): MRS. MYRIAM J. LLUCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A29-2 CALLE MANUELA WALKER URB ROLLING HILLS CARR 860
CAROLINA PR
00987
US

IV. Provider business mailing address

A29-2 CALLE MANUELA WALKER URB ROLLING HILLS CARR 860
CAROLINA PR
00987
US

V. Phone/Fax

Practice location:
  • Phone: 787-242-1920
  • Fax:
Mailing address:
  • Phone: 787-242-1920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: