Healthcare Provider Details

I. General information

NPI: 1568556868
Provider Name (Legal Business Name): LUZ N TORRES SANTIAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 AVE MATIAS BRUGMAN
LAS MARIAS PR
00670-2009
US

IV. Provider business mailing address

PO BOX 331
LAS MARIAS PR
00670-0331
US

V. Phone/Fax

Practice location:
  • Phone: 787-827-3165
  • Fax: 787-827-3925
Mailing address:
  • Phone: 787-827-3165
  • Fax: 787-827-3925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number11F2489
License Number StatePR

VIII. Authorized Official

Name: LUZ SANTIAGO
Title or Position: OWNER
Credential:
Phone: 787-827-3165