Healthcare Provider Details

I. General information

NPI: 1285168856
Provider Name (Legal Business Name): YAZMIN MALDONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 157 KM 23.2 BARROS
OROCOVIS PR
00720-1224
US

IV. Provider business mailing address

PO BOX 1224
OROCOVIS PR
00720-1224
US

V. Phone/Fax

Practice location:
  • Phone: 787-867-4012
  • Fax:
Mailing address:
  • Phone: 787-867-4012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number8549
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: