Healthcare Provider Details

I. General information

NPI: 1841364239
Provider Name (Legal Business Name): AIZA Y PEREZ CABAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 110 KM 13 PT 0 BO PUEBLO
MOCA PR
00676
US

IV. Provider business mailing address

PO BOX 57
MOCA PR
00676-0057
US

V. Phone/Fax

Practice location:
  • Phone: 787-877-0110
  • Fax: 787-818-0110
Mailing address:
  • Phone: 787-877-0110
  • Fax: 787-818-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number17F2076
License Number StatePR

VIII. Authorized Official

Name: AIZA PEREZ
Title or Position: OWNER
Credential:
Phone: 787-877-0110