Healthcare Provider Details

I. General information

NPI: 1386700060
Provider Name (Legal Business Name): MR. FELIX R. BULTRON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35-27 CALLE 16 VILLA CAROLINA
CAROLINA PR
00985-5440
US

IV. Provider business mailing address

35-27 CALLE 16 VILLA CAROLINA
CAROLINA PR
00985-5440
US

V. Phone/Fax

Practice location:
  • Phone: 787-257-8540
  • Fax: 787-257-6760
Mailing address:
  • Phone: 787-257-8540
  • Fax: 787-257-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2413
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: