Healthcare Provider Details

I. General information

NPI: 1225256340
Provider Name (Legal Business Name): ABIGAIL OQUENDO BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 187 KM 7.0 MEDIANIA ALTA
LOIZA PR
00772
US

IV. Provider business mailing address

VIA PIEDRAS RE-8 RIO CRISTAL ENCANTADA
TRUJILLO ALTO PUERTO RICO
00976
UM

V. Phone/Fax

Practice location:
  • Phone: 787-876-1927
  • Fax:
Mailing address:
  • Phone: 787-400-3595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number004329
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: