Healthcare Provider Details

I. General information

NPI: 1740492446
Provider Name (Legal Business Name): ARACELIS PENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

F35 CALLE B RPTO MONTELLANO
CAYEY PR
00736-4118
US

IV. Provider business mailing address

F35 CALLE B RPTO MONTELLANO
CAYEY PR
00736-4118
US

V. Phone/Fax

Practice location:
  • Phone: 787-738-3876
  • Fax: 787-274-8477
Mailing address:
  • Phone: 787-738-3876
  • Fax: 787-274-8477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2149
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: