Healthcare Provider Details

I. General information

NPI: 1588164602
Provider Name (Legal Business Name): YAIRA OCASIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 AVE ESMERALDA
GUAYNABO PR
00969-4429
US

IV. Provider business mailing address

47 AVE ESMERALDA
GUAYNABO PR
00969-4429
US

V. Phone/Fax

Practice location:
  • Phone: 787-789-2683
  • Fax: 787-789-2683
Mailing address:
  • Phone: 787-789-2683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: