Healthcare Provider Details

I. General information

NPI: 1235443599
Provider Name (Legal Business Name): DR. ILIANA ALICEA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 3 BOX 8911
GURABO PR
00778-9772
US

IV. Provider business mailing address

HC 3 BOX 8911
GURABO PR
00778-9772
US

V. Phone/Fax

Practice location:
  • Phone: 787-412-6782
  • Fax:
Mailing address:
  • Phone: 787-412-6782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number27907R
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: