Healthcare Provider Details

I. General information

NPI: 1619170875
Provider Name (Legal Business Name): ADA NAHIR OCASIO CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

963 CALLE MUNOZ RIVERA
PENUELAS PR
00624-1401
US

IV. Provider business mailing address

HC 01 BOX 12719
PENUELAS PR
00624-9716
US

V. Phone/Fax

Practice location:
  • Phone: 787-836-2173
  • Fax: 787-836-6102
Mailing address:
  • Phone: 787-226-9830
  • Fax: 787-836-6102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number3878
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: