Healthcare Provider Details

I. General information

NPI: 1073654240
Provider Name (Legal Business Name): ABDULLAH A YASSIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 9 E-10
DOS RIOS-VALPARAISO PR
00949
US

IV. Provider business mailing address

E10 CALLE 9
TOA BAJA PR
00949-4038
US

V. Phone/Fax

Practice location:
  • Phone: 787-795-4181
  • Fax: 787-753-7108
Mailing address:
  • Phone: 787-784-5265
  • Fax: 787-784-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3819
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: