Healthcare Provider Details

I. General information

NPI: 1205194586
Provider Name (Legal Business Name): MRS. MARY LUZ ESPINELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 73 BOX 5029
NARANJITO PR
00719-9139
US

IV. Provider business mailing address

HC 73 BOX 5029
NARANJITO PR
00719-9139
US

V. Phone/Fax

Practice location:
  • Phone: 787-368-2262
  • Fax:
Mailing address:
  • Phone: 787-368-2262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number1808
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: