Healthcare Provider Details

I. General information

NPI: 1588768584
Provider Name (Legal Business Name): MRS. MINERVA TUBENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE MILITAR #4406 BO COTTO
ISABELA PR
00662
US

IV. Provider business mailing address

HC 02 BOX 12350
MOCA PR
00676
US

V. Phone/Fax

Practice location:
  • Phone: 787-872-5943
  • Fax: 787-830-4788
Mailing address:
  • Phone: 787-877-7615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number4990
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: