Healthcare Provider Details

I. General information

NPI: 1134347636
Provider Name (Legal Business Name): CDT DRES VILLALOBOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE FERNANDEZ JUNCOS ESQUINA MOLINILLO
CAROLINA PR
00982
US

IV. Provider business mailing address

PO BOX 193044
SAN JUAN PR
00919-3044
US

V. Phone/Fax

Practice location:
  • Phone: 787-257-4320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberNABP4022101
License Number StatePR

VIII. Authorized Official

Name: RAUL VILLALOBOS
Title or Position: PRESIDENT
Credential:
Phone: 787-257-4320